# MHS PRIMARY CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588132625
- **Authorized official:** ANNE LESICZKA (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (860) 358-4811

## Contact information

- **Practice address:** 1353 BOSTON POST RD, MADISON, CT 06443-3445
- **Practice address phone:** (203) 245-4933
- **Mailing address:** 28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
- **Mailing address phone:** (860) 358-4820
- **Mailing address fax:** (860) 358-8661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 11/09/2018