| NPI | 1164463840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAIN PATRIE Credentialing Specialist 860-347-6971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 0392) |
| 207R00000X Internal Medicine (Licence: CT 0392) | |
| 208000000X Pediatrics (Licence: CT 0392) | |
| 207V00000X Obstetrics & Gynecology | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-07-23 |