1295806636 NPI number — O'NEILL HEALTH CLINIC, INC.

Table of content: (NPI 1295806636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295806636 NPI number — O'NEILL HEALTH CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'NEILL HEALTH CLINIC, 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:
DUFFY HEALTH CENTER
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:
1295806636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 BRANT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-776-2656
Provider Business Mailing Address Fax Number:
508-790-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-1218
Provider Business Practice Location Address Fax Number:
508-771-0070
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOYER
Authorized Official First Name:
CLAIRE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
508-771-9599

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  113425 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1588616742 . This is a "NATIONAL PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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