URGENT CARE OF DERBY, LLC (NPI# 1629461116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629461116 |
| Entity Type | Organization |
| Organization Name | URGENT CARE OF DERBY, LLC |
| Other Organization Name | PHYSICIANONE URGENT CARE- DERBY |
| Practice Address |
78 Pershing Dr Derby CT 06418-1433 |
| Mailing Address |
2928 Main St Glastonbury CT 06033-1007 |
| Practice Telephone | 2035165307 |
| Mailing Telephone | 8606578289 |
| Mailing Fax Number | 8606578291 |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |
| Authorized Official Name | JEANNIE M KENKARE (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 8606578289 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008049245 | 05 | |
| CT | 008056635 | 05 | |
| CT | 008049195 | 05 | |
| CT | 008049246 | 05 |
| Other Name | Type Code |
|---|---|
| PhysicianOne Urgent Care- Derby | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | URGENT CARE OF DERBY, LLC | 31 Old Route 7, Brookfield, CT 06804 |
| Street Address |
78 PERSHING DR |
| City | DERBY |
| State | CT |
| Zip Code | 06418-1433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134599541 | Nikolett Kocsis | Physician Assistant | 78 Pershing Dr, Derby, CT 06418-1433 | 2015-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942839105 | Fnu Prinkiya | Student in an Organized Health Care Education/Training Program | Griffin Hospital. 130 Division St, Derby, CT 06418 | 2020-04-08 |
| 1942837935 | Ivanshi A Gondalia | Student in an Organized Health Care Education/Training Program | Griffin Hospital, 130 Division St, Derby, CT 06418 | 2020-03-27 |
| 1972168094 | Pir Saad | Student in an Organized Health Care Education/Training Program | C/o Margie Bliga, Department of Medical Education, Griffin Hospital, 130 Division St, Derby, CT 06418 | 2019-05-03 |
| 1295398899 | Ahtsham Yousaf Chaudhary | Student in an Organized Health Care Education/Training Program | 130 Division St, Griffin Hospital, Derby, CT 06418 | 2019-04-18 |
| 1477016376 | Rabia Usman | Student in an Organized Health Care Education/Training Program | 130 Division St. Griffin Hospital, Derby, CT 06418 | 2019-04-09 |
| 1932661428 | Meshal Qaiser | Student in an Organized Health Care Education/Training Program | 130 Division Street Griffin Hospital, Derby, CT 06418 | 2019-04-03 |
| 1275027666 | Victoria Anne Hodge Enquist | Social Worker | 241 Seymour Avenue, Griffin Hospital Iop, Seymour, CT 06418 | 2018-06-19 |
| 1811485758 | Nimeshayan Varatharajah | Student in an Organized Health Care Education/Training Program | Griffin Hospital, 130 Division St., Derby, CT 06418 | 2018-04-26 |
| 1851889836 | Pete Prashamsa Shenoy | Student in an Organized Health Care Education/Training Program | Griffin Hospital (dpt of Graduate Medical Education), 130 Division St., Derby, CT 06418 | 2018-04-25 |
| 1639696594 | Samantha Leigh Bassett | Counselor | 90 Sodom Lane, Derby, CT 06418 | 2017-08-23 |
| Find all providers in zip 06418 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790130458 | Family Medcenters, P.a. | Clinic/Center | 1101 N Rock Rd, Derby, KS 67037-3705 | 2016-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548804628 | Urgent Care of West Hartford, LLC | Clinic/Center | 21 N Main St Ste B, West Hartford, CT 06107-1939 | 2019-11-01 |
| 1467937268 | Ctuc01 | Clinic/Center | 1171 E Main St, Torrington, CT 06790-3963 | 2018-09-27 |
| 1972035657 | New England Urgent Care Enfield LLC | Clinic/Center | 370 Middle Tpke W, Manchester, CT 06040-3824 | 2017-03-31 |
| 1396276960 | Ctuc01 | Clinic/Center | 76 Newtown Rd., Suite C, Danbury, CT 06810 | 2017-03-24 |
| 1922539592 | Ctuc01 | Clinic/Center | 179 Talcottville Rd, Vernon, CT 06066 | 2017-03-24 |
| 1134665698 | Bloomfield Urgent Care, LLC | Clinic/Center | 16 Mountain Ave, Bloomfield, CT 06002-2339 | 2017-01-09 |
| 1053856039 | Qmg3, LLC | Clinic/Center | 389 Bridgeport Ave, Shelton, CT 06824-5484 | 2016-12-29 |
| 1437546363 | Qmg2,llc | Clinic/Center | 1910 Black Rock Tpke, Fairfield, CT 06825-3543 | 2015-04-17 |
| 1558753574 | Ctuc01 | Clinic/Center | 100 Mill Plain Road, Danbury, CT 06811 | 2015-02-27 |
| 1457759755 | New England Urgent Care Enfield LLC | Clinic/Center | 575 Farmington Ave, Unit 51, Bristol, CT 06010-3933 | 2014-12-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.