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
1 SHAWS CV, NEW LONDON, CT 06320-4902
(860) 447-8304
(860) 443-8720
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
0229
CT
213E00000X
Podiatrist
0229
CT
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236338
—
CT
05
—
004236346
—
CT
05
—
004236354
—
CT
Enumeration date
01/03/2008
Last updated
10/30/2012
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