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MAIN MEDICAL-MYSTIC LLC NPI 1003001850

NPI Profile

NPI: 1003001850
Provider Name: MAIN MEDICAL-MYSTIC, LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
23 CLARA DR
SUITE 201
MYSTIC, CT
ZIP 06355
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Phone: (860) 536-1666

MAIN MEDICAL-MYSTIC, LLC is a healthcare provider in Mystic, CT.The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. MAIN MEDICAL-MYSTIC, LLC NPI is 1003001850. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

23 CLARA DR
SUITE 201
MYSTIC, CT
ZIP 06355-959
Phone: (860) 536-1666
Fax: (860) 536-9770

The provider's authorized official is Roy Martin Main .
The authorized official title is Owner/physician and has the following contact phone number (860) 536-1666.

The enumeration date for this NPI number is 9/13/2007 and was last updated on 9/13/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1207R00000XInternal Medicine031865CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C02861MEDICARE PINCONNECTICUT
2B30093MEDICARE UPINCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 10/13/2019

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