Provider Demographics
NPI:1295151934
Name:CONNECTICUT URGENT CARE CENTERS, LLC
Entity type:Organization
Organization Name:CONNECTICUT URGENT CARE CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GALLACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-378-8585
Mailing Address - Street 1:136 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2627
Mailing Address - Country:US
Mailing Address - Phone:860-378-8585
Mailing Address - Fax:860-378-8586
Practice Address - Street 1:136 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2627
Practice Address - Country:US
Practice Address - Phone:860-378-8585
Practice Address - Fax:860-378-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QU0200X, 207P00000X, 207R00000X, 363L00000X, 363A00000X
CT0739261Q00000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100187528OtherMEDICARE GROUP PTAN
CT008056570Medicaid
CT07D2075714OtherCLIA