Organization
ELLIS MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LENWORTH ELLIS M.D. (MANAGING MEMBER)
(860) 243-1864
Entity
Organization
Contact information
Practice address
701 COTTAGE GROVE RD, SUITE A110, BLOOMFIELD, CT 06002-3080
(860) 243-1864
Mailing address
701 COTTAGE GROVE RD, SUITE A110, BLOOMFIELD, CT 06002-3080
(860) 243-1864
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
041803
CT
Other
Enumeration date
04/30/2009
Last updated
04/30/2009
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