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General NPI Number Information
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NPI Number | 1275302317
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Entity Type | Organization
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Legal Business Name | NVR & SDD CONVENIENT CARE LLC
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 339 SQUIRE RD
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City | REVERE
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State | MA
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Zip | 02151-6148
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Country | US
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Telephone | 781-354-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 137 TURNPIKE STREET
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City | NORTH ANDOVER
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State | MA
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Zip | 01845
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Country | US
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Telephone | 781-354-1485
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Fax |
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Authorized Official
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Title or Position | MANAGER/ SOC SIGNATORY
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Name | MR. RANGANARAYAN NARASIMHAN
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Credential |
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Telephone | 781-354-1485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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