| NPI | 1912182338 |
|---|---|
| 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 0264) |
| 207R00000X Internal Medicine (Licence: CT 0264) | |
| 208000000X Pediatrics (Licence: CT 0264) | |
| 213E00000X Podiatrist (Licence: CT 0264) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2012-11-01 |