Healthcare Provider Details

I. General information

NPI: 1992001457
Provider Name (Legal Business Name): MASHPEE SERVICE UNIT/INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date: 03/21/2023
Reactivation Date: 05/03/2023

III. Provider practice location address

483 GREAT NECK ROAD SOUTH BUILDING 002-HEALTH CLINIC
MASHPEE MA
02649
US

IV. Provider business mailing address

483 GREAT NECK ROAD SOUTH BUILDING 001-ADMIN BUILDING
MASHPEE MA
02649
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-0209
  • Fax: 508-477-1936
Mailing address:
  • Phone: 508-477-0209
  • Fax: 508-477-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS LORRAINE REELS-PEARSON
Title or Position: HEALTH SERVICE ADMINISTRATOR-CEO
Credential:
Phone: 508-477-6913