Provider Demographics
NPI:1124362686
Name:COUNTRY DOC WALK-IN &WELLNESS LLC
Entity Type:Organization
Organization Name:COUNTRY DOC WALK-IN &WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-535-4600
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:N STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-0417
Mailing Address - Country:US
Mailing Address - Phone:860-535-4600
Mailing Address - Fax:860-535-4605
Practice Address - Street 1:391 NORWICH WESTERLY RD
Practice Address - Street 2:
Practice Address - City:N STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-9992
Practice Address - Country:US
Practice Address - Phone:860-535-4600
Practice Address - Fax:860-535-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center