=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174042337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223-225 LINCOLN AVE. SUITE 231A
-----------------------------------------------------
City | HAVERHILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-373-8630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 MALL RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEX BARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-830-2006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------