Provider Demographics
NPI:1174928790
Name:PEDIATRIC HOUSE CALL SOLUTIONS LLC
Entity type:Organization
Organization Name:PEDIATRIC HOUSE CALL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:WETMORE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-893-5394
Mailing Address - Street 1:62 PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7639
Mailing Address - Country:US
Mailing Address - Phone:203-893-5394
Mailing Address - Fax:855-766-3951
Practice Address - Street 1:167 CHERRY ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-7639
Practice Address - Country:US
Practice Address - Phone:203-893-5394
Practice Address - Fax:855-766-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty