Provider Demographics
NPI:1710191135
Name:PLAINFIELD WALK IN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PLAINFIELD WALK IN MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-564-4054
Mailing Address - Street 1:558 NORWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1725
Mailing Address - Country:US
Mailing Address - Phone:860-564-4054
Mailing Address - Fax:860-564-0354
Practice Address - Street 1:558 NORWICH RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1725
Practice Address - Country:US
Practice Address - Phone:860-564-4054
Practice Address - Fax:860-564-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379199Medicaid
CT010037919CT01OtherBLUE CROSS BLUE SHIELD
CT001379199Medicaid
CT080001568Medicare ID - Type Unspecified