Provider Demographics
NPI:1497474191
Name:AMPLE URGENT AND PRIMARY CARE LLC
Entity Type:Organization
Organization Name:AMPLE URGENT AND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOJDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDARI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-DNP
Authorized Official - Phone:860-707-5392
Mailing Address - Street 1:10 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1893
Mailing Address - Country:US
Mailing Address - Phone:860-707-5392
Mailing Address - Fax:
Practice Address - Street 1:10 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1893
Practice Address - Country:US
Practice Address - Phone:860-707-5392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care