Organization
MHS PRIMARY CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MARTIN (VP FINANCE)
(860) 358-3005
Entity
Organization
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
023007
CT
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
023007
CT
363A00000X
Physician Assistant
000621
CT
363LF0000X
Family Nurse Practitioner
002921
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008073532
—
CT
05
—
04173259
—
CT
05
—
04181343
—
CT
05
—
04201084
—
CT
Enumeration date
03/06/2007
Last updated
05/03/2021
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