NPIMap

Organization Active NPI

Physician Services of Northeast

  • Clinic/Center
  • Putnam, CT
National Provider Identifier
1174809966
Registry record updated Oct 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PHYSICIAN SERVICES OF NORTHEAST
Practice address
320 Pomfret St
Putnam, CT 06260-1836
Phone
(860) 928-6541
Fax
(860) 963-6450
NPI assigned
Oct 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2011

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

Authorized official

Name
Christine L Vallee
Title
VP Physician Services
Phone
(860) 928-6541

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 176B00000X
Clinic/Center 261Q00000X Primary
Advanced Practice MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 367A00000X

Addresses

Primary practice location

320 Pomfret St
Putnam, CT 06260-1836

Mailing address

PO Box 8469
Belfast, ME 04915-8469
Phone (860) 928-6541

Other identifiers 1

IdentifierTypeStateIssuer
008001905MedicaidCT

Other names 1

  • PHYSICIAN SERVICES OF NORTHEAST CT, LLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Physician Services of Northeast6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319500800000",
    "number": "1174809966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8469",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049158469",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 POMFRET ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601836",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF NORTHEAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2011-10-25",
        "status": "A",
        "authorized_official_last_name": "VALLEE",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "860-928-6541"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008001905",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIAN SERVICES OF NORTHEAST CT, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Putnam, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; 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.