Ralphola Taylor Community Center | |
790 Central Ave Bridgeport CT 06607-1705 | |
(203) 332-4567 | |
(203) 332-0376 |
Full Name | Ralphola Taylor Community Center |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 790 Central Ave, Bridgeport, Connecticut |
Authorized Official Name and Position | Ludwig Spinelli (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2036963260 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Ralphola Taylor Community Center 982 E Main St Bridgeport CT 06608-1913 Ph: (203) 696-3260 | Ralphola Taylor Community Center 790 Central Ave Bridgeport CT 06607-1705 Ph: (203) 332-4567 |
NPI Number | 1174893648 |
---|---|
Provider Enumeration Date | 12/30/2011 |
Last Update Date | 12/30/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174893648 | NPI | - | NPPES |
C00383 | Other | CT | MEDICARE PART B |
004234788 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0200 (Connecticut) | Primary |
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Primed Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4699 Main St, Suite 105 Attn: Med3000, Bridgeport, CT 06606 Phone: 203-944-1940 Fax: 203-402-4196 | |
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