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1010 South Main Street Fall River MA 02724-2855 | |
(508) 675-1054 | |
(508) 324-7777 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1010 South Main Street, Fall River, Massachusetts |
Authorized Official Name and Position | Linda Schofield (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5086751054 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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386 Stanley St Fall River MA 02720-6009 Ph: (508) 675-1054 | 1010 South Main Street Fall River MA 02724-2855 Ph: (508) 675-1054 |
NPI Number | 1902176449 |
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Provider Enumeration Date | 12/30/2011 |
Last Update Date | 01/05/2015 |
Medicare PECOS PAC ID | 0244129542 |
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Medicare Enrollment ID | O20120727000390 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902176449 | NPI | - | NPPES |
4379 | Other | MA | DPH CLINIC LICENSE |
22D0938610 | Other | CLIA LAB |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1-F00000909-11-01 (* (Not Available)) | Primary |
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