Pride Comprehensive Primary Care LLC
Clinic/Center, Primary Care in Wolcott, CT. Organization (NPI-2).
NPI number1699307751
StatusActive
Last updated in NPPESFeb 6, 2020
Details
- NPI
- 1699307751
- Entity type
- Organization (NPI-2)
- Legal business name
- Pride Comprehensive Primary Care LLC
- Organization subpart
- No
- Enumeration date
- Feb 6, 2020
- Certification date
- Feb 6, 2020
- Last updated
- Feb 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Practice location
7 Warren RdWolcott, CT 06716-3015
Phone 414-614-5832
Mailing address
7 Warren RdWolcott, CT 06716-3015
Phone 414-614-5832
Authorized official
Jurg W. J. Oggenfuss
Chief Medical Officer
4146145832
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