Healthcare Provider Details

I. General information

NPI: 1962792200
Provider Name (Legal Business Name): SOUTH END COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2000
  • Fax: 617-424-8725
Mailing address:
  • Phone: 617-425-2000
  • Fax: 617-424-8725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4031
License Number StateMA

VIII. Authorized Official

Name: ROBERT JOHNSON
Title or Position: CEO
Credential: SR
Phone: 617-425-2000