MEDICARE: IMMEDIATE MEDICAL CARE OF MONROE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	000204	CT

General Provider Information

NPI Number	:	1346451721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMEDIATE MEDICAL CARE OF MONROE

Provider Business Mailing Address
First Line	:	388 MAIN ST
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1150
Country	:	US
Telephone Number	:	203-459-0191
Fax Number	:	203-459-0192

Provider Business Practice Location Address
First Line	:	388 MAIN ST
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1150
Country	:	US
Telephone Number	:	203-459-0191
Fax Number	:	203-459-0192

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PATRICIA BARRETT
Credential	:
Telephone Number	:	203-459-0191

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	04/22/2008

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Directions to “IMMEDIATE MEDICAL CARE OF MONROE ” Practice Location

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