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100 Linwood Ave Fl 1 Colchester CT 06415-1138 | |
| (630) 207-2556 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 100 Linwood Ave Fl 1, Colchester, Connecticut |
| Authorized Official Name and Position | Srinivasulu Conjeevaram (OWNER) |
| Authorized Official Contact | 6302072557 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
100 Linwood Ave Fl 1 Colchester CT 06415-1138 Ph: (630) 207-2556 | 100 Linwood Ave Fl 1 Colchester CT 06415-1138 Ph: (630) 207-2556 |
| NPI Number | 1225702566 |
|---|---|
| Provider Enumeration Date | 08/02/2021 |
| Last Update Date | 03/17/2022 |
| Medicare PECOS PAC ID | 4284020850 |
|---|---|
| Medicare Enrollment ID | O20220407000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225702566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Srinivasulu Conjeevaram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780958058 PECOS PAC ID: 6103054655 Enrollment ID: I20150709000399 |
| Provider Name | Jacob Bigbi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710649363 PECOS PAC ID: 2567854649 Enrollment ID: I20220122000091 |
Colchester Internal Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 199 Old Hartford Rd, Unit #6, Colchester, CT 06415 Phone: 860-537-2262 Fax: 860-537-2273 | |
Colchester Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 123 Broadway St, Colchester, CT 06415 Phone: 860-537-3204 Fax: 860-537-3208 |