Provider Demographics
NPI:1609865757
Name:VERNON URGENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:VERNON URGENT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-871-6939
Mailing Address - Street 1:224 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4701
Mailing Address - Country:US
Mailing Address - Phone:860-871-6939
Mailing Address - Fax:860-871-2601
Practice Address - Street 1:224 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4701
Practice Address - Country:US
Practice Address - Phone:860-871-6939
Practice Address - Fax:860-871-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CT026993261QE0002X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004062014Medicaid
CTD100213042Medicare UPIN