1982848867 NPI number — COORDINATED PRIMARY CARE, INC.

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 1982848867 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:
CPC PARKHILL FAMILY PRACTICE
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:
1982848867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 FRANKLIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420-5140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-345-1919
Provider Business Mailing Address Fax Number:
978-342-6240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 FRANKLIN 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:
01420-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-345-1919
Provider Business Practice Location Address Fax Number:
978-342-6240
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FABELLO
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
978-466-4268

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; 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".




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