Provider Demographics
NPI:1134665698
Name:BLOOMFIELD URGENT CARE, LLC
Entity Type:Organization
Organization Name:BLOOMFIELD URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-205-3544
Mailing Address - Street 1:16 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2339
Mailing Address - Country:US
Mailing Address - Phone:860-205-3544
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2339
Practice Address - Country:US
Practice Address - Phone:860-205-3544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care