Basic Information
| Provider Information | |||||||||
| NPI: | 1336792720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | URGENT CARE OF BERLIN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2928 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060331007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604301246 | ||||||||
| FaxNumber: | 2039056824 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 WEBSTER SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060372328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604203660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | KENKARE | ||||||||
| AuthorizedOfficialFirstName: | JEANNIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 2036164440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.