Pediatric Walk in Care LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

032413 Issued in CT

Legal business name

PEDIATRIC WALK IN CARE LLC

Practice address

141 B Hazard Avenue
Enfield, CT 06082-5412

Phone

(860) 749-7603

Fax

(860) 749-7604

NPI assigned

Nov 18, 2013

Last updated

Nov 18, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Hemant K Panchal, M.D.

Title

Owner

Phone

(860) 749-7603

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1073943668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 B HAZARD AVENUE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060825412",
            "telephone_number": "860-749-7603",
            "fax_number": "860-749-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 B HAZARD AVENUE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060825412",
            "telephone_number": "860-749-7603",
            "fax_number": "860-749-7604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC WALK IN CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "PANCHAL",
        "authorized_official_first_name": "HEMANT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-749-7603",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "032413",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "032413",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001324136",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.