Provider Demographics
NPI:1043852569
Name:ST. VINCENTS URGENT CARE LLC
Entity Type:Organization
Organization Name:ST. VINCENTS URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LLATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-210-5346
Mailing Address - Street 1:2720 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5363
Mailing Address - Country:US
Mailing Address - Phone:475-210-5346
Mailing Address - Fax:
Practice Address - Street 1:900 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5727
Practice Address - Country:US
Practice Address - Phone:203-696-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST VINCENT'S MULTISPECIALTY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty