Provider Demographics
NPI:1356433486
Name:WINDSOR LOCKS MEDICAL CENTER, LLP
Entity type:Organization
Organization Name:WINDSOR LOCKS MEDICAL CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-627-0161
Mailing Address - Street 1:73 OLD COUNTY ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096
Mailing Address - Country:US
Mailing Address - Phone:860-627-0161
Mailing Address - Fax:860-292-1327
Practice Address - Street 1:73 OLD COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096
Practice Address - Country:US
Practice Address - Phone:860-627-0161
Practice Address - Fax:860-292-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026154207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTHEALTHNETOtherOV1001