Basic Information
Provider Information
NPI: 1760146153
EntityType: 2
ReplacementNPI:  
OrganizationName: URGENT CARE OF ROCKY HILL, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 2928 MAIN ST STE 101
Address2:  
City: GLASTONBURY
State: CT
PostalCode: 060331007
CountryCode: US
TelephoneNumber: 8604301246
FaxNumber: 8606560669
Practice Location
Address1: 396 CROMWELL AVE
Address2:  
City: ROCKY HILL
State: CT
PostalCode: 060671828
CountryCode: US
TelephoneNumber: 8553492828
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/22/2021
LastUpdateDate: 10/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KENKARE
AuthorizedOfficialFirstName: JEANNIE
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: CMO
AuthorizedOfficialTelephone: 2036164440
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DO
NPICertificationDate: 10/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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