Organization Name: | MHS PRIMARY CARE |
NPI Number: | 1104043017 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN SERKEY (PRACTICE ADMINISTRATOR) |
Mailing Address: | 154 Main St Old Saybrook |
State: | CT US |
Postal Code: | 064752373 |
Phone Number: | 8603951212 |
Fax Number: | 8603588654 |
NPI Enumeration Date: | 04/20/2007 |
NPI Last Update Date: | 04/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |