Provider Demographics
NPI:1316369895
Name:STAMFORD UC PC
Entity Type:Organization
Organization Name:STAMFORD UC PC
Other - Org Name:AFC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:RADULOVACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-969-2000
Mailing Address - Street 1:3000 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4311
Mailing Address - Country:US
Mailing Address - Phone:203-969-2000
Mailing Address - Fax:
Practice Address - Street 1:3000 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4311
Practice Address - Country:US
Practice Address - Phone:203-969-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty