FEEL WELL HEALTH CENTER OF SOUTHINGTON, PC - NPI NUMBER 1306103502

Summary

Provider Name: FEEL WELL HEALTH CENTER OF SOUTHINGTON, PC

NPI Number: 1306103502

Clasification: Non-Pharmacy Dispensing Site (332900000X)

Address:
710 MAIN ST
BLDG 4
PLANTSVILLE, CT
ZIP 06479

Phone Number: (860) 378-2892



Detailed Information

FEEL WELL HEALTH CENTER OF SOUTHINGTON, PC is a non-pharmacy dispensing site in Plantsville, CT. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) The assigned NPI number for this provider is 1306103502 and is registered as an organization entity type.

The provider's business address is:

710 MAIN ST
BLDG 4
PLANTSVILLE, CT
ZIP 06479-565
Phone: (860) 378-2892

The provider's authorized official is Kevin P Greene .
The authorized official title is President and has the following contact phone number (860) 378-2892.

The enumeration date for this NPI number is 4/12/2012 and was last updated on 4/13/2012.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 332900000X Non-Pharmacy Dispensing Site Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1306103502 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name FEEL WELL HEALTH CENTER OF SOUTHINGTON, PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 710 MAIN ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address BLDG 4 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name PLANTSVILLE The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name CT The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 064791565 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 8603782892 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 4/12/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 4/13/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name GREENE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name KEVIN The first name of the authorized official.
16 Authorized Official Middle Name P The middle name of the authorized official.
17 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
18 Authorized Official Telephone Number 8603782892 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 332900000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart Y
22 Parent Organization LBN FEEL WELL HEALTH CENTER OF SOUTHINGTON, PC
23 Parent Organization TIN
24 Authorized Official Name Prefix Text DR.
25 Authorized Official Credential Text MD


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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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