Organization
MHS PRIMARY CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN SERKEY (NETWORK EXECUTIVE)
(860) 358-4802
Entity
Organization
Contact information
Practice address
27 COMMERCE ST, CLINTON, CT 06413-2054
(860) 669-8659
(860) 669-4382
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
—
CT
207R00000X
Internal Medicine Physician
Primary
—
CT
363A00000X
Physician Assistant
—
CT
363LF0000X
Family Nurse Practitioner
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004173259
—
CT
05
—
004181343
—
CT
05
—
004201084
—
CT
Enumeration date
12/10/2014
Last updated
12/10/2014
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