Healthcare Provider Details

I. General information

NPI: 1639378441
Provider Name (Legal Business Name): COORDINATED PRIMARY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N MAIN ST
LEOMINSTER MA
01453-1814
US

IV. Provider business mailing address

60 HOSPITAL RD
LEOMINSTER MA
01453-2205
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-8820
  • Fax:
Mailing address:
  • Phone: 978-466-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency 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: MR. JOHN EDWARD BRONHARD II
Title or Position: CFO
Credential:
Phone: 978-870-1550