Provider Demographics
NPI:1841526068
Name:THE URGENT CARE CENTER OF CONNECTICUT, LLC
Entity type:Organization
Organization Name:THE URGENT CARE CENTER OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-242-0034
Mailing Address - Street 1:421 COTTAGE GROVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3119
Mailing Address - Country:US
Mailing Address - Phone:860-242-3933
Mailing Address - Fax:860-242-3301
Practice Address - Street 1:421 COTTAGE GROVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3119
Practice Address - Country:US
Practice Address - Phone:860-242-3933
Practice Address - Fax:860-242-3301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLINS MEDICAL ASSOCIATES 2 PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-22
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018911207Q00000X, 207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008017921Medicaid