| Manchester Family Care Llc | |
|
75 Joseph Ln South Windsor CT 06074-1416 | |
| (860) 648-4402 | |
| Not Available |
| Full Name | Manchester Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 75 Joseph Ln, South Windsor, Connecticut |
| Authorized Official Name and Position | Mohammed A Memon (PHYSICIAN) |
| Authorized Official Contact | 8606484402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manchester Family Care Llc 75 Joseph Ln South Windsor CT 06074-1416 Ph: (860) 648-4402 | Manchester Family Care Llc 75 Joseph Ln South Windsor CT 06074-1416 Ph: (860) 648-4402 |
| NPI Number | 1740395755 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0042236960 |
|---|---|
| Medicare Enrollment ID | O20080204000063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740395755 | NPI | - | NPPES |
| C03418 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 042588 (Connecticut) | Primary |
| Provider Name | Mohammed A Memon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609826668 PECOS PAC ID: 4880662212 Enrollment ID: I20040922001072 |
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