Provider Demographics
NPI:1386980191
Name:FAMILY HEALTH URGENT CARE
Entity type:Organization
Organization Name:FAMILY HEALTH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-847-2600
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2720
Mailing Address - Country:US
Mailing Address - Phone:203-847-2600
Mailing Address - Fax:203-849-3081
Practice Address - Street 1:235 MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-9993
Practice Address - Country:US
Practice Address - Phone:203-847-2600
Practice Address - Fax:203-547-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty