Healthcare Provider Details

I. General information

NPI: 1083006738
Provider Name (Legal Business Name): WOONSOCKET URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROVIDENCE HWY
EAST WALPOLE MA
02032-1512
US

IV. Provider business mailing address

103 PROVIDENCE HWY
EAST WALPOLE MA
02032-1512
US

V. Phone/Fax

Practice location:
  • Phone: 781-255-0500
  • Fax: 781-255-0400
Mailing address:
  • Phone: 781-255-0500
  • Fax: 781-255-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PAUL VALLERA
Title or Position: CEO
Credential: P.A.
Phone: 781-255-0500