Wellness Locker, Llc | |
5a Sunset Ave Putnam CT 06260-2915 | |
(860) 481-2950 | |
(860) 928-4079 |
Full Name | Wellness Locker, Llc |
---|---|
Speciality | Family Medicine |
Location | 5a Sunset Ave, Putnam, Connecticut |
Authorized Official Name and Position | Olivia Shea Locker (PROPRIETOR) |
Authorized Official Contact | 8604812950 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Wellness Locker, Llc 5a Sunset Ave Putnam CT 06260-2915 Ph: (860) 481-2950 | Wellness Locker, Llc 5a Sunset Ave Putnam CT 06260-2915 Ph: (860) 481-2950 |
NPI Number | 1922479369 |
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Provider Enumeration Date | 10/12/2015 |
Last Update Date | 10/21/2024 |
Medicare PECOS PAC ID | 6305148214 |
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Medicare Enrollment ID | O20160111000131 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922479369 | NPI | - | NPPES |
008062229 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 53961 (Connecticut) | Primary |
Provider Name | Olivia S Locker |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336218304 PECOS PAC ID: 4385946292 Enrollment ID: I20160111000213 |
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