1760599518 NPI number — WILTON MEDICAL WALK IN CLINIC INC

Table of content: (NPI 1760599518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760599518 NPI number — WILTON MEDICAL WALK IN CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILTON MEDICAL WALK IN CLINIC INC
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:
1760599518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 DANBURY RD
Provider Second Line Business Mailing Address:
UNIT 5 WILTON MEDICAL WALK-IN CLINIC INC
Provider Business Mailing Address City Name:
WILTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-834-8885
Provider Business Mailing Address Fax Number:
203-834-8889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 DANBURY RD
Provider Second Line Business Practice Location Address:
UNIT 5 WILTON MEDICAL WALK-IN CLINIC INC
Provider Business Practice Location Address City Name:
WILTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-834-8885
Provider Business Practice Location Address Fax Number:
203-834-8889
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHORMAN
Authorized Official First Name:
DEIRDRE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT WILTON MEDICAL WALK IN CL
Authorized Official Telephone Number:
203-834-8885

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  000272 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 015149 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C02476 . This is a "PTAN NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040000272CT01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V6049 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010015149CT02 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: OV4868 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".




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