| |
1500 District Ave Burlington MA 01803-5069 | |
(508) 444-8851 | |
(508) 657-8338 |
Full Name | |
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Speciality | Family Medicine |
Location | 1500 District Ave, Burlington, Massachusetts |
Authorized Official Name and Position | Henry Lubega (FOUNDER/CEO) |
Authorized Official Contact | 7753380442 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4 Riverhurst Rd Apt 440 Billerica MA 01821-6603 Ph: (775) 338-0442 | 1500 District Ave Burlington MA 01803-5069 Ph: (508) 444-8851 |
NPI Number | 1992416739 |
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Provider Enumeration Date | 12/13/2022 |
Last Update Date | 06/28/2023 |
Medicare PECOS PAC ID | 8325404346 |
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Medicare Enrollment ID | O20230517002899 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992416739 | NPI | - | NPPES |
110191140 | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Henry Lubega |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295491553 PECOS PAC ID: 9234595257 Enrollment ID: I20230531000431 |
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