Full Name | |
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Speciality | Clinic/Center |
Location | 39 Route 171, Woodstock, Connecticut |
Authorized Official Name and Position | Rose Kihara (APRN) |
Authorized Official Contact | 8603151198 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 922 Woodstock CT 06281-3044 Ph: (860) 315-1198 | 39 Route 171 Woodstock CT 06281 Ph: (860) 776-0187 |
NPI Number | 1952890105 |
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Provider Enumeration Date | 05/03/2018 |
Last Update Date | 04/03/2020 |
Medicare PECOS PAC ID | 4486904950 |
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Medicare Enrollment ID | O20180904001444 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952890105 | NPI | - | NPPES |
008023376 | Medicaid | CT |
Provider Name | Rose Kihara |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649506445 PECOS PAC ID: 7416128020 Enrollment ID: I20110912000235 |