NPIMap

Organization Active NPI

Branch Medical Clinic Groton

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Groton, CT
National Provider Identifier
1972564243
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
BRANCH MEDICAL CLINIC GROTON
Practice address
1 Wahoo Ave
Box 600, Code 42G
Groton, CT 06340-2324
Phone
(860) 694-2556
Fax
(860) 694-4843
NPI assigned
Mar 28, 2006
Organization subpart
Yes
Parent organization
NAVAL HEALTH CLINIC NEW ENGLANDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Authorized official

Name
William M Condon
Title
Bumed Ubo
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X CT Primary

Addresses

Primary practice location

1 Wahoo Ave
Box 600, Code 42G
Groton, CT 06340-2324

Mailing address

PO Box 600
Groton, CT 06349-5600
Phone (860) 694-2556

National Provider Directory

National Provider Directory
Tax ID family
Newport Memorial Hospital - Navy Resource Sharing10 organizations share this tax ID, including this one
Part of
Newport Memorial Hospital - Navy Resource Sharing

Other organizations with this tax ID 9

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

Locations

1 Wahoo Ave
#600
Groton, CT 06349
Phone (860) 694-2556

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1972564243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063495600",
            "telephone_number": "860-694-2556",
            "fax_number": "860-694-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE",
            "address_2": "BOX 600, CODE 42G",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063402324",
            "telephone_number": "860-694-2556",
            "fax_number": "860-694-4843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCH MEDICAL CLINIC GROTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL HEALTH CLINIC NEW ENGLAND",
        "enumeration_date": "2006-03-28",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUMED UBO",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Groton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.