Prime Healthcare LTC PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIME HEALTHCARE LTC PC

Practice address

30 Jordan LN
Wethersfield, CT 06109-1278

Phone

(860) 263-0263

Fax

(860) 263-0267

NPI assigned

Jul 15, 2024

Organization subpart

No

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

Authorized official

Name

Wayne Paulekas, MD

Title

MD/Owner

Phone

(860) 263-0263

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1326886359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0263",
            "fax_number": "860-263-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0263",
            "fax_number": "860-263-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE LTC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "PAULEKAS",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "860-263-0263",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.