Provider Demographics
NPI:1639155997
Name:MED- EAST ASSOCIATES LLC
Entity Type:Organization
Organization Name:MED- EAST ASSOCIATES LLC
Other - Org Name:MED EAST MEDICAL WALK IN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-456-1252
Mailing Address - Street 1:200 MERROW RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3416
Mailing Address - Country:US
Mailing Address - Phone:860-456-1252
Mailing Address - Fax:860-456-2278
Practice Address - Street 1:200 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3416
Practice Address - Country:US
Practice Address - Phone:860-456-1252
Practice Address - Fax:860-456-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004088755Medicaid
CT004088755Medicaid