Healthcare Provider Details

I. General information

NPI: 1043292634
Provider Name (Legal Business Name): FAMILIY CARE CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 MAIN ST
TEWKSBURY MA
01876-3125
US

IV. Provider business mailing address

PO BOX 760
WINCHESTER MA
01890-4260
US

V. Phone/Fax

Practice location:
  • Phone: 978-658-9931
  • Fax: 978-694-0991
Mailing address:
  • Phone: 781-756-7273
  • Fax: 781-756-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77556
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216439
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59949
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70939
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number182929
License Number StateMA

VIII. Authorized Official

Name: EILEEN WILLS
Title or Position: BILLING MANAGER
Credential:
Phone: 781-756-7273