Healthcare Provider Details

I. General information

NPI: 1215304589
Provider Name (Legal Business Name): HEYWOOD AFFILIATED MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MAIN ST
GARDNER MA
01440-2927
US

IV. Provider business mailing address

242 GREEN ST ADMIN ANNEX
GARDNER MA
01440-1336
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS J SULLIVAN
Title or Position: CEO
Credential:
Phone: 978-630-6157