Provider Demographics
NPI:1457759755
Name:NEW ENGLAND URGENT CARE ENFIELD LLC
Entity Type:Organization
Organization Name:NEW ENGLAND URGENT CARE ENFIELD LLC
Other - Org Name:NEW ENGLAND URGENT CARE ENFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-236-3911
Mailing Address - Street 1:575 FARMINGTON AVE
Mailing Address - Street 2:UNIT 51
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3933
Mailing Address - Country:US
Mailing Address - Phone:860-845-5763
Mailing Address - Fax:860-745-7077
Practice Address - Street 1:575 FARMINGTON AVE
Practice Address - Street 2:UNIT 51
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3933
Practice Address - Country:US
Practice Address - Phone:860-845-5763
Practice Address - Fax:860-745-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100080451Medicare PIN