Provider Demographics
NPI:1194489583
Name:UC OF SOUTHINGTON, LLC
Entity Type:Organization
Organization Name:UC OF SOUTHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENKARE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-616-4440
Mailing Address - Street 1:2928 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1007
Mailing Address - Country:US
Mailing Address - Phone:860-430-1246
Mailing Address - Fax:860-656-0669
Practice Address - Street 1:365 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1884
Practice Address - Country:US
Practice Address - Phone:855-349-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care