Provider Demographics
NPI:1437810462
Name:CT MEDICAL CLINICS
Entity Type:Organization
Organization Name:CT MEDICAL CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEOFFRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-351-5528
Mailing Address - Street 1:17 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1700
Mailing Address - Country:US
Mailing Address - Phone:860-351-5528
Mailing Address - Fax:
Practice Address - Street 1:17 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1700
Practice Address - Country:US
Practice Address - Phone:860-351-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty