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PHYSICIAN SERVICES OF NORTHEAST NPI 1174809966


NPI Information

NPI: 1174809966
Provider Name: PHYSICIAN SERVICES OF NORTHEAST

Other Name: PHYSICIAN SERVICES OF NORTHEAST CT, LLC

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
320 POMFRET ST
PUTNAM, CT
ZIP 06260
Phone: (860) 928-6541
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PHYSICIAN SERVICES OF NORTHEAST is a clinic center in Putnam, CT. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PHYSICIAN SERVICES OF NORTHEAST NPI is 1174809966. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Physician Services Of Northeast Ct, Llc.

The provider's business location address is:

320 POMFRET ST
PUTNAM, CT
ZIP 06260-836
Phone: (860) 928-6541
Fax: (860) 963-6450

The provider's authorized official is Christine L Vallee .
The authorized official title is Vp Physician Services and has the following contact phone number (860) 928-6541.

The enumeration date for this NPI number is 10/25/2011 and was last updated on 10/25/2011.


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
1176B00000XMidwifeNo
2367A00000XAdvanced Practice MidwifeNo
3261Q00000XClinic/CenterYes

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
1008001905MEDICAIDCONNECTICUT
2D100000012MEDICARE PINCONNECTICUT

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: 5/5/2024

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