Healthcare Provider Details

I. General information

NPI: 1073995700
Provider Name (Legal Business Name): NUCH OF MASSACHUSETTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 ANDREW AVENUE
WAYLAND MA
01778
US

IV. Provider business mailing address

84 ANDREW AVENUE
WAYLAND MA
01778
US

V. Phone/Fax

Practice location:
  • Phone: 774-806-2101
  • Fax: 774-806-2102
Mailing address:
  • Phone: 774-806-2101
  • Fax: 774-806-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP, OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2902