Provider Demographics
NPI:1346451721
Name:IMMEDIATE MEDICAL CARE OF MONROE
Entity Type:Organization
Organization Name:IMMEDIATE MEDICAL CARE OF MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-459-0191
Mailing Address - Street 1:388 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1150
Mailing Address - Country:US
Mailing Address - Phone:203-459-0191
Mailing Address - Fax:203-459-0192
Practice Address - Street 1:388 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1150
Practice Address - Country:US
Practice Address - Phone:203-459-0191
Practice Address - Fax:203-459-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000204261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care