Provider Demographics
NPI:1518394428
Name:URGENT CARE OF SOUTHINGTON LLC
Entity type:Organization
Organization Name:URGENT CARE OF SOUTHINGTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:GORENBEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-372-4990
Mailing Address - Street 1:365 QUEEN STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-372-4990
Mailing Address - Fax:860-372-4699
Practice Address - Street 1:365 QUEEN STREET
Practice Address - Street 2:UNIT 4
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-372-4990
Practice Address - Fax:860-372-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty