Provider Demographics
NPI:1568938900
Name:URGENT CARE OF STRATFORD, LLC
Entity Type:Organization
Organization Name:URGENT CARE OF STRATFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENKARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-430-1246
Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-6339
Mailing Address - Country:US
Mailing Address - Phone:860-650-3848
Mailing Address - Fax:
Practice Address - Street 1:1040 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4968
Practice Address - Country:US
Practice Address - Phone:860-430-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care