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110 W Squantum St North Quincy MA 02171-2122 | |
(617) 376-3000 | |
(617) 774-1905 |
Full Name | |
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Speciality | Clinic/Center |
Location | 110 W Squantum St, North Quincy, Massachusetts |
Authorized Official Name and Position | Cynthia Sierra (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 6174044101 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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110 W Squantum St North Quincy MA 02171-2122 Ph: (617) 376-3030 | 110 W Squantum St North Quincy MA 02171-2122 Ph: (617) 376-3000 |
NPI Number | 1467483297 |
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Provider Enumeration Date | 07/06/2006 |
Last Update Date | 03/03/2023 |
Medicare PECOS PAC ID | 4486555158 |
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Medicare Enrollment ID | O20050310000992 |
Identifier | Type | State | Issuer |
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1467483297 | NPI | - | NPPES |
1300571 | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4801 (Massachusetts) | Primary |