Provider Demographics
NPI:1922781616
Name:ESSEX URGENT & PRIMARY CARE PROVIDERS PC
Entity Type:Organization
Organization Name:ESSEX URGENT & PRIMARY CARE PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-851-8750
Mailing Address - Street 1:34 BLAIR PARK RD # 264
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7991
Mailing Address - Country:US
Mailing Address - Phone:850-797-0754
Mailing Address - Fax:
Practice Address - Street 1:21 ESSEX WAY STE 116
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:VT
Practice Address - Zip Code:05452-3386
Practice Address - Country:US
Practice Address - Phone:802-851-8750
Practice Address - Fax:802-851-8765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFC ESSEX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care