Organization Name: | MHS PRIMARY CARE |
NPI Number: | 1538386420 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN SERKEY (NETWORK EXECUTIVE) |
Mailing Address: | 80 Shunpike Rd Suite 301 Cromwell |
State: | CT US |
Postal Code: | 064164401 |
Phone Number: | 8606325570 |
Fax Number: | 8603588650 |
NPI Enumeration Date: | 04/20/2007 |
NPI Last Update Date: | 09/09/2013 |
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: |