| NPI | 1467482539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RUSH CFO 860-822-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CT 0299) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 0299) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CT 0299) | |
| 207V00000X Obstetrics & Gynecology (Licence: CT 0299) | |
| 208000000X Pediatrics (Licence: CT 0299) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 0299) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-07-03 |