1649241019 NPI number — COORDINATED PRIMARY CARE, INC.

Table of content: (NPI 1649241019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649241019 NPI number — COORDINATED PRIMARY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COORDINATED PRIMARY CARE, 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:
MATERNAL FETAL MONITORING 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:
1649241019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 MENDON RD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02864-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-334-2423
Provider Business Mailing Address Fax Number:
401-334-9808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 BELMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-334-6255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COFONE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
978-466-2185

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9771476 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 637436 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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