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2000 N Main St Waterbury CT 06704-2364 | |
| (203) 951-8306 | |
| (475) 215-3374 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2000 N Main St, Waterbury, Connecticut |
| Authorized Official Name and Position | Terrence Morton (SR. MEDICAL DIRECTOR) |
| Authorized Official Contact | 7733521515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
30 W Monroe St Ste 1200 Chicago IL 60603-2420 Ph: (773) 352-1515 | 2000 N Main St Waterbury CT 06704-2364 Ph: (203) 951-8306 |
| NPI Number | 1093561136 |
|---|---|
| Provider Enumeration Date | 04/29/2024 |
| Last Update Date | 07/24/2024 |
| Medicare PECOS PAC ID | 7810428166 |
|---|---|
| Medicare Enrollment ID | O20240927001112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093561136 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kendra S Lawrence |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861415762 PECOS PAC ID: 4789718420 Enrollment ID: I20100817000140 |
| Provider Name | Raxine Avis Christie-campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679009716 PECOS PAC ID: 4880961507 Enrollment ID: I20170601000659 |
| Provider Name | Bernadette Nadira Agard-henriques |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235214669 PECOS PAC ID: 4587634084 Enrollment ID: I20240927001418 |
| Provider Name | Melissa Schneider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992370241 PECOS PAC ID: 1456750009 Enrollment ID: I20241014004799 |
| Provider Name | Quanza Mooring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770281016 PECOS PAC ID: 8224402920 Enrollment ID: I20241028001180 |
| Provider Name | Robin B Allen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629068440 PECOS PAC ID: 8921154667 Enrollment ID: I20241121002260 |
| Provider Name | Mira Desai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538559190 PECOS PAC ID: 6800104787 Enrollment ID: I20241122002353 |
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