Provider Demographics
NPI:1093138935
Name:MHS PRIMARY CARE INC
Entity Type:Organization
Organization Name:MHS PRIMARY CARE INC
Other - Org Name:MIDDLESEX HOSPITAL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-358-3005
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:MIDDLESEX HOSPITAL URGENT CARE
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4870
Mailing Address - Fax:860-358-6748
Practice Address - Street 1:154 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2373
Practice Address - Country:US
Practice Address - Phone:860-661-5976
Practice Address - Fax:860-358-8664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MHS PRIMARY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-29
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X, 207R00000X, 261QU0200X, 363A00000X, 363LF0000X
363AM0700X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008061130Medicaid
CT008061268Medicaid
CT008050108Medicaid
CT008050909Medicaid
CT008050909Medicaid