Provider Demographics
NPI:1831187145
Name:MED NOW PC
Entity type:Organization
Organization Name:MED NOW PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-377-5733
Mailing Address - Street 1:1040 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4968
Mailing Address - Country:US
Mailing Address - Phone:203-377-5733
Mailing Address - Fax:203-380-0851
Practice Address - Street 1:1040 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4968
Practice Address - Country:US
Practice Address - Phone:203-377-5733
Practice Address - Fax:203-380-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0528740001Medicare NSC
CTC00638Medicare PIN