| |
20 Maple Street Maple Street School Vernon CT 06066 | |
(860) 647-6592 | |
(860) 290-4142 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 20 Maple Street, Vernon, Connecticut |
Authorized Official Name and Position | Eugene A Market (CEO) |
Authorized Official Contact | 8606106131 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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94 Connecticut Boulevard East Hartford CT 06108 Ph: (860) 610-6131 | 20 Maple Street Maple Street School Vernon CT 06066 Ph: (860) 647-6592 |
NPI Number | 1669874855 |
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Provider Enumeration Date | 09/19/2014 |
Last Update Date | 07/01/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669874855 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0734 (Connecticut) | Primary |
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