Provider Demographics
NPI:1073959664
Name:PRIMARY HEALTH L.L.C
Entity Type:Organization
Organization Name:PRIMARY HEALTH L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-247-2500
Mailing Address - Street 1:60 GILLETT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2637
Mailing Address - Country:US
Mailing Address - Phone:860-247-2500
Mailing Address - Fax:860-247-2800
Practice Address - Street 1:60 GILLETT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2637
Practice Address - Country:US
Practice Address - Phone:860-247-2500
Practice Address - Fax:860-247-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty