| Stacy Kirkpatrick House | |
|
461 Walnut Ave Jamaica Plain MA 02130 | |
| (857) 654-1550 | |
| (857) 654-1471 |
| Full Name | Stacy Kirkpatrick House |
|---|---|
| Speciality | Clinic/Center |
| Location | 461 Walnut Ave, Jamaica Plain, Massachusetts |
| Authorized Official Name and Position | Agnes W Leung (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8576541200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy Kirkpatrick House 780 Albany St Boston MA 02118-2755 Ph: (857) 654-1227 | Stacy Kirkpatrick House 461 Walnut Ave Jamaica Plain MA 02130 Ph: (857) 654-1550 |
| NPI Number | 1942663851 |
|---|---|
| Provider Enumeration Date | 03/30/2016 |
| Last Update Date | 05/25/2018 |
| Medicare PECOS PAC ID | 2668475419 |
|---|---|
| Medicare Enrollment ID | O20160825000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942663851 | NPI | - | NPPES |
| 110020876Q | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4LQX (Massachusetts) | Primary |
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