Organization
COMMUNITY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BAIN PATRIE (CREDENTIALING SPECIALIST)
(860) 347-6971
Entity
Organization
Contact information
Practice address
481 GOLD STAR HWY, SUITE 100, GROTON, CT 06340-6702
(860) 446-8858
(860) 405-2140
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0261
CT
207R00000X
Internal Medicine Physician
0261
CT
208000000X
Pediatrics Physician
0261
CT
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
01/03/2008
Last updated
09/28/2012
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