| Mary Lou Strom Primary Care Center | |
|
5 N Main St Enfield CT 06082-3339 | |
| (860) 253-9024 | |
| (860) 253-9124 |
| Full Name | Mary Lou Strom Primary Care Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 N Main St, Enfield, Connecticut |
| Authorized Official Name and Position | Bain Patrie (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8603476971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lou Strom Primary Care Center 575 Main St Fl 2 Attn: Credentialing Dept Middletown CT 06457-2845 Ph: (860) 347-6971 | Mary Lou Strom Primary Care Center 5 N Main St Enfield CT 06082-3339 Ph: (860) 253-9024 |
| NPI Number | 1679761027 |
|---|---|
| Provider Enumeration Date | 10/11/2007 |
| Last Update Date | 10/30/2012 |
| Medicare PECOS PAC ID | 0547169138 |
|---|---|
| Medicare Enrollment ID | O20090824000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679761027 | NPI | - | NPPES |
| 004236346 | Medicaid | CT | |
| 004236338 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Connecticut) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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