Provider Demographics
NPI:1548305584
Name:FEEL WELL HEALTH CENTER OF SOUTHINGTON, P.C.
Entity type:Organization
Organization Name:FEEL WELL HEALTH CENTER OF SOUTHINGTON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-378-2891
Mailing Address - Street 1:710 MAIN ST BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1567
Mailing Address - Country:US
Mailing Address - Phone:860-378-2891
Mailing Address - Fax:860-378-2894
Practice Address - Street 1:710 MAIN ST BLDG 4
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1567
Practice Address - Country:US
Practice Address - Phone:860-378-2891
Practice Address - Fax:860-378-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245082Medicaid
CTC02892Medicare ID - Type Unspecified