Provider Demographics
NPI:1598135899
Name:URGENT CARE OF HAMDEN, LLC
Entity Type:Organization
Organization Name:URGENT CARE OF HAMDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENKARE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-885-0808
Mailing Address - Street 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1711
Mailing Address - Country:US
Mailing Address - Phone:203-885-0808
Mailing Address - Fax:203-885-0813
Practice Address - Street 1:2165 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2116
Practice Address - Country:US
Practice Address - Phone:860-241-2727
Practice Address - Fax:866-405-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008056635Medicaid
CT008058210Medicaid
CT008049245Medicaid
CT008049195Medicaid
CT008049246Medicaid
CT008049246Medicaid