| |
163 N Main St North Brookfield MA 01535-1400 | |
(508) 637-1604 | |
(508) 637-1605 |
Full Name | |
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Speciality | Clinic/Center |
Location | 163 N Main St, North Brookfield, Massachusetts |
Authorized Official Name and Position | Lorraine Bock (OWNER) |
Authorized Official Contact | 7174439970 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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163 N Main St North Brookfield MA 01535-1400 Ph: (508) 637-1604 | 163 N Main St North Brookfield MA 01535-1400 Ph: (508) 637-1604 |
NPI Number | 1588322390 |
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Provider Enumeration Date | 11/30/2021 |
Last Update Date | 05/16/2022 |
Medicare PECOS PAC ID | 6507245461 |
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Medicare Enrollment ID | O20220623000707 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588322390 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Wendy Sergeant |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871687459 PECOS PAC ID: 1850483835 Enrollment ID: I20070822000834 |
Provider Name | Laura T Black |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295068161 PECOS PAC ID: 7012134471 Enrollment ID: I20140807001595 |
Provider Name | Michelle M Dedon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669960274 PECOS PAC ID: 0941559108 Enrollment ID: I20180821002304 |
Provider Name | Jennifer Para |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770962094 PECOS PAC ID: 5294031464 Enrollment ID: I20200707003106 |
Provider Name | Lorraine Wentz Bock |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730164450 PECOS PAC ID: 3678543188 Enrollment ID: I20220623000808 |
Provider Name | Joanna H Jung |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326366444 PECOS PAC ID: 9638523517 Enrollment ID: I20230926002885 |