| Staywell South Main | |
|
1302 S Main St Waterbury CT 06706-1748 | |
| (203) 756-8021 | |
| (203) 596-9038 |
| Full Name | Staywell South Main |
|---|---|
| Speciality | Family Medicine |
| Location | 1302 S Main St, Waterbury, Connecticut |
| Authorized Official Name and Position | Donald Thompson (PRESIDENT) |
| Authorized Official Contact | 2037568021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staywell South Main 80 Phoenix Ave Ste 201 Waterbury CT 06702-1418 Ph: (203) 756-8021 | Staywell South Main 1302 S Main St Waterbury CT 06706-1748 Ph: (203) 756-8021 |
| NPI Number | 1932355567 |
|---|---|
| Provider Enumeration Date | 08/14/2008 |
| Last Update Date | 02/08/2018 |
| Medicare PECOS PAC ID | 6305750480 |
|---|---|
| Medicare Enrollment ID | O20081023000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932355567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0360 (Connecticut) | Secondary |
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