1023348638 NPI number — UPHAM'S CORNER HEALTH COMMITTEE INC.

Table of content: (NPI 1023348638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023348638 NPI number — UPHAM'S CORNER HEALTH COMMITTEE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPHAM'S CORNER HEALTH COMMITTEE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UPHAM'S COMMUNITY CARE - PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023348638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 COLUMBIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02125-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-287-8000
Provider Business Mailing Address Fax Number:
617-282-8625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 COLUMBIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02125-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-265-1310
Provider Business Practice Location Address Fax Number:
617-265-1654
Provider Enumeration Date:
01/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TRIVEDI
Authorized Official First Name:
JAGDEEP
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
617-287-8000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X , with the licence number: MA0058176 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110024263G , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2123348 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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