| Park City Primary Care Center | |
|
64 Black Rock Ave Bridgeport CT 06605-1200 | |
| (203) 579-5000 | |
| (203) 332-0376 |
| Full Name | Park City Primary Care Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 64 Black Rock Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Ludwig Spinelli (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2036963260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park City Primary Care Center 982 E Main St Bridgeport CT 06608-1913 Ph: (203) 696-3260 | Park City Primary Care Center 64 Black Rock Ave Bridgeport CT 06605-1200 Ph: (203) 579-5000 |
| NPI Number | 1932479409 |
|---|---|
| Provider Enumeration Date | 12/30/2011 |
| Last Update Date | 12/30/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932479409 | NPI | - | NPPES |
| C00383 | Other | CT | MEDICARE PART B |
| 004234788 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0388 (Connecticut) | Primary |
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