1538346846 NPI number — CLOUTIER FAMILY PRACTICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538346846 NPI number — CLOUTIER FAMILY PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLOUTIER FAMILY PRACTICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538346846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 HIGHWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIANTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06357-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-758-7888
Provider Business Mailing Address Fax Number:
860-365-6961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL BRANCH HEALTH CLINIC
Provider Second Line Business Practice Location Address:
1 WAHOO DRIVE
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-694-1523
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CLOUTIER
Authorized Official First Name:
JOSEE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
860-389-2546

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1790860419 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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