Mystic Medical Group, Pc

LBN: Mystic Medical Group, Pc
Mystic Medical Group, Pc is an health care organization with primary practice located at 200 Sandy Hollow Rd , Mystic CT 06355-1720. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as the primary health care specialty. Mystic Medical Group, Pc can be contacted via phone (860) 572-8911, or through Blum, Thomas March via phone (860) 572-8911.

Contact Information

Primary practice address
200 Sandy Hollow Rd Mystic CT 06355-1720
Phone: (860) 572-8911
Fax: (860) 572-7758
Website:
Map and Directions
Authorized official contact:
Name: Blum, Thomas March Doctor of Medicine (MD)
Phone: (860) 572-8911

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X

Profile Details

NPI number 1902891070
LBN Legal business name Mystic Medical Group, Pc
DBA Doing business as
Authorized official Blum, Thomas March Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 15th, 2005
Last updated Dec 22nd, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1902891070 NPPES
Connecticut MEDICAID 004002861

Popular Providers