1477535813 NPI number — COORDINATED PRIMARY CARE

Table of content: (NPI 1477535813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477535813 NPI number — COORDINATED PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COORDINATED PRIMARY CARE
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:
ONCOLOGY ASSOCIATES
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:
1477535813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-466-4243
Provider Business Mailing Address Fax Number:
978-466-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 NICHOLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-343-5048
Provider Business Practice Location Address Fax Number:
978-343-5549
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FABELLO
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR COORDINATOR PRIMARY CARE
Authorized Official Telephone Number:
978-466-4243

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: M20928 , 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: M20928 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 977147C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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