Organization
AVON FAMILY HEALTH, LLC
Active
Parent organization
AVON PROFESSIONAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVON PROFESSIONAL GROUP
Authorized official
MARY ELIZABETH LEAHY APRN (MEMBER)
(860) 675-6595
Entity
Organization
Contact information
Practice address
30 W AVON RD, SUITE D, AVON, CT 06001-3678
(860) 675-6595
(860) 673-6721
Mailing address
30 W AVON RD, SUITE D, AVON, CT 06001-3678
(860) 675-6595
(860) 673-6721
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004238003
—
CT
01
—
11000341
GROUP MEDICAID
CT
01
—
1100341
GROUP MEDICARE PTAN
—
01
—
11243173
CAQH
—
01
—
1669496113
TRICARE
—
01
—
637238
WELLCARE
—
01
—
7327000
CIGNA
—
01
—
D400060973
MEDICARE PTAN
—
01
—
P4395587
OXFORD
—
Enumeration date
03/04/2016
Last updated
07/20/2017
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