| |
484 Lowell St Ste 2a Peabody MA 01960-7917 | |
(978) 896-6600 | |
(978) 896-6610 |
Full Name | |
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Speciality | Clinic/Center |
Location | 484 Lowell St Ste 2a, Peabody, Massachusetts |
Authorized Official Name and Position | Ijeoma Onwuogu (ADMINISTRATOR) |
Authorized Official Contact | 9788966600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6 Paul Ave Peabody MA 01960-2621 Ph: (978) 896-6600 | 484 Lowell St Ste 2a Peabody MA 01960-7917 Ph: (978) 896-6600 |
NPI Number | 1891532420 |
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Provider Enumeration Date | 07/11/2024 |
Last Update Date | 07/15/2024 |
Certification Date | 07/15/2024 |
Medicare PECOS PAC ID | 8729525415 |
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Medicare Enrollment ID | O20240730003511 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891532420 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Provider Name | Ijeoma Onwuogu |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356042204 PECOS PAC ID: 0840519138 Enrollment ID: I20230606002818 |
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