| Intercommunity, Inc. | |
|
281 Main St East Hartford CT 06118-1823 | |
| (860) 569-5900 | |
| Not Available |
| Full Name | Intercommunity, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 281 Main St, East Hartford, Connecticut |
| Authorized Official Name and Position | Kimberly Beauregard (PRESIDENT & CEO) |
| Authorized Official Contact | 8602911340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercommunity, Inc. 111 Founders Plz Suite 1802 East Hartford CT 06108-3212 Ph: (860) 569-5900 | Intercommunity, Inc. 281 Main St East Hartford CT 06118-1823 Ph: (860) 569-5900 |
| NPI Number | 1962896548 |
|---|---|
| Provider Enumeration Date | 03/23/2015 |
| Last Update Date | 06/08/2016 |
| Medicare PECOS PAC ID | 9032001649 |
|---|---|
| Medicare Enrollment ID | O20150428000738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962896548 | NPI | - | NPPES |
| 008047966 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 702 (Connecticut) | Primary |
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