| NPI | 1063884146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY MCCULLOUGH CEO 860-477-0961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: RI MD06257) |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology | |
| 2085R0001X Radiology, Radiation Oncology | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 207R00000X Internal Medicine (Licence: RI MD06257) | |
| 125Q00000X Oral Medicinist | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MA 52697) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2018-04-17 |