1518971860 NPI number — PRIMARY PHYSICIAN PARTNERS

Table of content: (NPI 1518971860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518971860 NPI number — PRIMARY PHYSICIAN PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY PHYSICIAN PARTNERS
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:
PRIMARY PHYSICIAN PARTNERS
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:
1518971860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2793
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01613-2793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-363-7300
Provider Business Mailing Address Fax Number:
508-363-9688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 385N
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-363-7300
Provider Business Practice Location Address Fax Number:
508-363-9688
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
508-363-7707

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3101347 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41834 . This is a "NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 691558 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: M18243 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com