Healthcare Provider Details

I. General information

NPI: 1013284637
Provider Name (Legal Business Name): MERRIMACK MEDICAL & WALK IN S LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MARSTON ST STE 304
LAWRENCE MA
01841
US

IV. Provider business mailing address

25 MARSTON ST STE 304
LAWRENCE MA
01841
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-3100
  • Fax: 978-688-3133
Mailing address:
  • Phone: 978-688-3100
  • Fax: 978-688-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODY MICHAUD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 978-688-3100