1861439655 NPI number — PHYSICIANS HOMECARELLC

Table of content: (NPI 1861439655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861439655 NPI number — PHYSICIANS HOMECARELLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS HOMECARELLC
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:
6
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:
1861439655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ADAMS PL
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-7456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-930-3500
Provider Business Mailing Address Fax Number:
781-930-3570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 ORCHARD ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02744-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-994-3433
Provider Business Practice Location Address Fax Number:
508-994-5420
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TALBOT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-930-3500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0600075 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002113 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 002115 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0025129 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 697145 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000023561 . This is a "BOSTON MEDICAL CENTER HEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 002114 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1028506 . This is a "ACM/UNITE HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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