Organization
MHS PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN SERKEY (PRACTICE ADMINISTRATOR)
(860) 358-4802
Entity
Organization
Contact information
Practice address
154 MAIN ST, OLD SAYBROOK, CT 06475-2373
(860) 395-1212
(860) 358-8654
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-6748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
CT
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04173259
—
CT
Enumeration date
04/20/2007
Last updated
01/20/2017
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