Provider Demographics
NPI:1609495134
Name:WEST HARTFORD PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:WEST HARTFORD PRIMARY CARE, LLC
Other - Org Name:MENTALWELLNESSMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-698-3600
Mailing Address - Street 1:45 S MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2402
Mailing Address - Country:US
Mailing Address - Phone:860-698-3600
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2402
Practice Address - Country:US
Practice Address - Phone:860-698-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty