| Old Oak Primary Care, P.c. | |
|
250 Main St S Unit G Southbury CT 06488-2263 | |
| (203) 533-9436 | |
| (989) 419-3050 |
| Full Name | Old Oak Primary Care, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 250 Main St S Unit G, Southbury, Connecticut |
| Authorized Official Name and Position | Christofer John Fort (PRESIDENT) |
| Authorized Official Contact | 2035339436 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Oak Primary Care, P.c. 250 Main St S Unit G Southbury CT 06488-2263 Ph: (203) 533-9436 | Old Oak Primary Care, P.c. 250 Main St S Unit G Southbury CT 06488-2263 Ph: (203) 533-9436 |
| NPI Number | 1033697859 |
|---|---|
| Provider Enumeration Date | 08/02/2018 |
| Last Update Date | 12/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033697859 | NPI | - | NPPES |
| 008073500 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 056411 (Connecticut) | Primary |
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