1093268260 NPI number — PATRIOT URGENT CARE PROFESSIONALS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093268260 NPI number — PATRIOT URGENT CARE PROFESSIONALS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRIOT URGENT CARE PROFESSIONALS, PC
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:
Provider Other Organization Name Type Code:
6
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:
1093268260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 MAIN ST
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-7447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-894-6900
Provider Business Mailing Address Fax Number:
781-894-6901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 GREAT ROAD
Provider Second Line Business Practice Location Address:
UNIT 4A
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-459-5100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
617-459-5100

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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