1316003429 NPI number — CONCORD PRIMARY CARE,INC

Table of content: (NPI 1316003429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316003429 NPI number — CONCORD PRIMARY CARE,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORD 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:
Provider Other Organization Name Type Code:
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:
1316003429
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:
PO BOX 2669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-6669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-318-0007
Provider Business Mailing Address Fax Number:
978-318-0056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 OLD ROAD TO 9 ACRE COR
Provider Second Line Business Practice Location Address:
SUITE 810 JCB
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-318-0007
Provider Business Practice Location Address Fax Number:
978-318-0056
Provider Enumeration Date:
01/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOSHI
Authorized Official First Name:
VINEETA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAIN
Authorized Official Telephone Number:
978-318-0007

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  154169 , 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: J18209 . This is a "BCBS PROVIDER#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 137610 . This is a "TUFTS PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6405 . This is a "FALLON PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 17782053 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18857 . This is a "BCBSGROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2033845 . This is a "FIRST HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2115197 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 693861 . This is a "TUFTS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 400094 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 91080 . This is a "FALLON GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012166 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3168794 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3680770 . This is a "AETNA GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9734601 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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