| Southington Family Medical Center | |
|
1753 Meriden-waterbury Turnpike Milldale CT 06467 | |
| (860) 621-5554 | |
| (860) 621-3833 |
| Full Name | Southington Family Medical Center |
|---|---|
| Speciality | Family Medicine |
| Location | 1753 Meriden-waterbury Turnpike, Milldale, Connecticut |
| Authorized Official Name and Position | John Edwin Rivera (OWNER) |
| Authorized Official Contact | 8606215554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southington Family Medical Center Po Box 770 Milldale CT 06467-0770 Ph: (860) 621-5554 | Southington Family Medical Center 1753 Meriden-waterbury Turnpike Milldale CT 06467 Ph: (860) 621-5554 |
| NPI Number | 1902146996 |
|---|---|
| Provider Enumeration Date | 02/27/2013 |
| Last Update Date | 05/02/2013 |
| Medicare PECOS PAC ID | 2668614918 |
|---|---|
| Medicare Enrollment ID | O20130815000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902146996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 042567 (Connecticut) | Primary |
| Provider Name | John E Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720044811 PECOS PAC ID: 6204806193 Enrollment ID: I20040728000950 |
| Provider Name | Alyssa Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336421171 PECOS PAC ID: 9436303518 Enrollment ID: I20130128000160 |
| Provider Name | Erin E Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477004612 PECOS PAC ID: 6709166747 Enrollment ID: I20161208000093 |
Southington Family Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1753 Meriden-waterbury Rd, Milldale, CT 06467 Phone: 860-621-5554 Fax: 860-621-3833 |