MC DIAGNOSTIC OF CONNECTICUT, P.C. - NPI NUMBER 1386821932

Summary

Provider Name: MC DIAGNOSTIC OF CONNECTICUT, P.C.

NPI Number: 1386821932

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Address:
323 CROMWELL AVE
ROCKY HILL, CT
ZIP 06067

Phone Number: (401) 770-1768



Detailed Information

MC DIAGNOSTIC OF CONNECTICUT, P.C. is a family nurse practitioner in Rocky Hill, CT. The assigned NPI number for this provider is 1386821932 and is registered as an organization entity type and is a multiple single specialty group.

The provider's business address is:

323 CROMWELL AVE
ROCKY HILL, CT
ZIP 06067-801
Phone: (401) 770-1768
Fax: (401) 652-9787

The provider's authorized official is Linda Jackson .
The authorized official title is Administrator and has the following contact phone number (401) 770-1768.

The enumeration date for this NPI number is 1/25/2008 and was last updated on 6/27/2012.

Map - Location of Practice

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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 363LF0000X Nurse Practitioner Family Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 DO1751 OTHER CT MEDICARE RAILROAD
2 CO3843 MEDICARE PIN CT

NPI Record

No. Field Name Field Value
1 NPI 1386821932
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name MC DIAGNOSTIC OF CONNECTICUT, P.C.
5 Provider First Line Business Practice Location Address 323 CROMWELL AVE
6 Provider Business Practice Location Address City Name ROCKY HILL
7 Provider Business Practice Location Address State Name CT
8 Provider Business Practice Location Address Postal Code 060671801
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 4017701768
11 Provider Business Practice Location Address Fax Number 4016529787
12 Provider Enumeration Date 1/25/2008
13 Last Update Date 6/27/2012
14 Authorized Official Last Name JACKSON
15 Authorized Official First Name LINDA
16 Authorized Official Title or Position ADMINISTRATOR
17 Authorized Official Telephone Number 4017701768
18 Healthcare Provider Taxonomy Code 1 363LF0000X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 DO1751
21 Other Provider Identifier Type Code 1 01
22 Other Provider Identifier State 1 CT
23 Other Provider Identifier Issuer 1 MEDICARE RAILROAD
24 Other Provider Identifier 2 CO3843
25 Other Provider Identifier Type Code 2 08
26 Other Provider Identifier State 2 CT
27 Is Organization Subpart N
28 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.