Provider Demographics
NPI:1225702566
Name:COLCHESTER URGENT CARE CENTER LLC
Entity Type:Organization
Organization Name:COLCHESTER URGENT CARE CENTER LLC
Other - Org Name:THE URGENT CARE OF COLCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASULU
Authorized Official - Middle Name:
Authorized Official - Last Name:CONJEEVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-207-2557
Mailing Address - Street 1:100 LINWOOD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1138
Mailing Address - Country:US
Mailing Address - Phone:630-207-2556
Mailing Address - Fax:
Practice Address - Street 1:100 LINWOOD AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1138
Practice Address - Country:US
Practice Address - Phone:630-207-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty