| |
14 Manning Avenue Leominster MA 01453-5768 | |
(978) 847-0110 | |
(978) 847-0112 |
Full Name | |
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Speciality | Clinic/Center |
Location | 14 Manning Avenue, Leominster, Massachusetts |
Authorized Official Name and Position | John A Demalia (PRESIDENT AND CEO) |
Authorized Official Contact | 9788788510 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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326 Nichols Road Fitchburg MA 01420-1914 Ph: (978) 878-8100 | 14 Manning Avenue Leominster MA 01453-5768 Ph: (978) 847-0110 |
NPI Number | 1891953048 |
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Provider Enumeration Date | 05/23/2008 |
Last Update Date | 08/24/2022 |
Medicare PECOS PAC ID | 8729074992 |
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Medicare Enrollment ID | O20090220000517 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891953048 | NPI | - | NPPES |
1304780 | Medicaid | MA | |
M21400 | Other | MA | MEDICARE |
221893 | Other | WI | MEDICARE UGS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Massachusetts) | Primary |
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