Healthcare Provider Details

I. General information

NPI: 1013048347
Provider Name (Legal Business Name): EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 TACOMA ST
WORCESTER MA
01605-3516
US

IV. Provider business mailing address

650 LINCOLN ST
WORCESTER MA
01605-2060
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-2128
  • Fax: 508-595-1127
Mailing address:
  • Phone: 508-854-2122
  • Fax: 508-853-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number495
License Number StateMA

VIII. Authorized Official

Name: MR. STEPHEN J KERRIGAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 508-854-2122