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4 ELEMENTS DIRECT PRIMARY CARE LLC NPI 1730756636


NPI Information

NPI: 1730756636
Provider Name: 4 ELEMENTS DIRECT PRIMARY CARE LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 07D2184255

Address:
1199 SULLIVAN AVE STE A
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 469-5646
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4 ELEMENTS DIRECT PRIMARY CARE LLC is an internal medicine in South Windsor, 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. 4 ELEMENTS DIRECT PRIMARY CARE LLC NPI is 1730756636. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1199 SULLIVAN AVE STE A
SOUTH WINDSOR, CT
ZIP 06074-013
Phone: (860) 469-5646
Fax: (860) 310-1122

The provider's authorized official is Vasanth Kainkaryam .
The authorized official title is Managing Member and has the following contact phone number (860) 469-5656.

The CLIA number assigned to this NPI record is 07D2184255 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/8/2021 and was last updated on 6/8/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineYes
2208000000XPediatricsNo
32083B0002XPreventive MedicineObesity MedicineNo

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: 4/28/2024

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