MYSTIC MEDICAL ASSOCIATES LLC (NPI# 1972954477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972954477 |
| Entity Type | Organization |
| Organization Name | MYSTIC MEDICAL ASSOCIATES LLC |
| Practice Address |
12 Roosevelt Ave Second Floor Mystic CT 06355-2809 |
| Practice Telephone | 8602454126 |
| Practice Fax Number | 8602454128 |
| Mailing Telephone | 8602454126 |
| Mailing Fax Number | 8602454128 |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | CHRISTOPHER J ANDERSON (APRN) |
| Authorized Official Telephone | 8608156269 |
| Authorized Official Credential | MSN FNP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 230 S Main St., Suite #2, Cheshire, CT 064100641 | 8602454126 | 8779270171 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | MYSTIC MEDICAL ASSOCIATES LLC | 12 Roosevelt Ave, Second Fl, Mystic, CT 06355 |
| Street Address |
12 ROOSEVELT AVE SECOND FLOOR |
| City | MYSTIC |
| State | CT |
| Zip Code | 06355-2809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114993789 | Thomas Jeffrey Wagner | Optometrist | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2006-02-24 |
| 1679107411 | Optimystic LLC | Optometrist | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2020-03-02 |
| 1801353735 | Integrative Wellness Center, LLC | Naturopath | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2019-02-27 |
| 1164896189 | Natura Medica | Naturopath | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2015-11-16 |
| 1992175038 | Ana Gabriella Ruediger | Naturopath | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2015-10-01 |
| 1669889820 | Christopher J Anderson | Nurse Practitioner | 12 Roosevelt Ave, Second Floor, Mystic, CT 06355 | 2014-07-18 |
| 1598105595 | Dialect Pyschotherapy Inc. | Marriage & Family Therapist | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2013-07-05 |
| 1205138161 | Susanne G Taylor | Marriage & Family Therapist | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2010-11-29 |
| 1174853691 | Anne Rivers | Social Worker | 12 Roosevelt Ave, Suite 203, Mystic, CT 06355-2809 | 2010-01-06 |
| 1548449119 | Deirdre J. O'connor, N.d. | Naturopath | 12 Roosevelt Ave, Mystic, CT 06355-2809 | 2007-10-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770076069 | Brian Kristofer Owczarski | Physical Therapist | 80 Stonington Rd Ste A-3, Mystic, CT 06355 | 2018-06-11 |
| 1922554120 | Kayla Nickerson Gauthier | Marriage & Family Therapist | 41 Williams Ave, Mystic, CT 06355 | 2016-08-28 |
| 1417351156 | Lisa Pacifico | Physical Therapist | 44 Maritime Dive, Mystic, CT 06355 | 2014-10-09 |
| 1619386539 | Jennifer Rock | Occupational Therapist | 44 Maritime Drive, Pendleton Health and Rehab Center, Mystic, CT 06355 | 2014-08-05 |
| 1346565843 | Karen Lucille Hanscom | Psychologist | 47 Water St. #203, Mystic, CT 06355 | 2010-03-29 |
| 1346415627 | Eldon Richard Kilpatrick | Physical Therapy Assistant | 186 Jerry Browne Rd, Mystic, CT 06355 | 2008-04-28 |
| 1760688931 | Heather Elyse Geyer | Physical Therapist | 2440 Gold Star Hwy Suite 201, Mystic, CT 06355 | 2007-06-25 |
| 1982728754 | Falck Eye Center LLC | Ophthalmology | 35 Washington Street, Mystic, CT 06355 | 2007-03-19 |
| 1881724326 | Richard Irwin Steinberg | Dentist | 117 Cow Hill Road, Mystic, CT 06355 | 2007-03-06 |
| 1992890362 | Coastal Dermatology, P.C. | Dermatology | 55 Willow Street, Mystic, CT 06355 | 2006-10-03 |
| Find all providers in zip 06355 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1306447578 | Luca Health & Wellness, LLC | Clinic/Center | 2475 Albany Ave Ste 205, West Hartford, CT 06117-2523 | 2020-11-04 |
| 1699307751 | Pride Comprehensive Primary Care LLC | Clinic/Center | 7 Warren Rd, Wolcott, CT 06716-3015 | 2020-02-06 |
| 1316405186 | Ct Optimal Wellness, LLC | Clinic/Center | 115 Technology Dr Unit A103, Trumbull, CT 06611-6338 | 2019-03-11 |
| 1922586809 | Emmaus Health LLC | Clinic/Center | 945 Main St Ste 205, Manchester, CT 06040-6064 | 2018-08-01 |
| 1841781382 | Clifford W. Beers Guidance Clinic Inc | Clinic/Center | 41 Marne St, Hamden, CT 06514 | 2018-05-21 |
| 1598284622 | Np Wellness Care | Clinic/Center | 253 Fairlawn Dr, Torrington, CT 06790-5809 | 2017-09-09 |
| 1245773191 | Anchor Health Initiative Corp. | Clinic/Center | 30 Myano Ln Ste 16, Stamford, CT 06902-4532 | 2016-11-27 |
| 1588114870 | Whole Self Wellness, LLC | Clinic/Center | 144 Banjo Sullivan Rd, Griswold, CT 06351-1201 | 2016-10-11 |
| 1265892541 | Amanda M Swan Aprn LLC | Clinic/Center | 33 Harmund Pl, Wethersfield, CT 06109-1209 | 2016-03-01 |
| 1215321666 | Grand Medical LLC | Clinic/Center | 515 Higgins Rd, Cheshire, CT 06410-3326 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.