Organization
NES MEDICAL SERVICES OF NORTHERN CONNECTICUT, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BLAKEMAN (PROVIDER ENROLLMENT)
(469) 557-6183
Entity
Organization
Contact information
Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6368
Mailing address
7300 STATE HIGHWAY 121 STE 300-374, MCKINNEY, TX 75070-1987
(469) 557-6183
(469) 640-6671
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004265022
—
CT
05
—
110092181A
—
MA
01
—
500HBE168CT01
BCBS GROUP NUMBER
CT
Enumeration date
11/11/2005
Last updated
10/25/2024
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