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General NPI Number Information
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NPI Number | 1497984363
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Entity Type | Organization
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Legal Business Name | EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 72 UNION AVE
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City | FRAMINGHAM
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State | MA
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Zip | 01702-8216
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Country | US
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Telephone | 508-270-5700
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Fax | 508-370-3637
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Provider Business Mailing Address
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Address Line | 115 NE CUTOFF STE 200
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City | WORCESTER
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State | MA
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Zip | 01606-1224
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Country | US
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Telephone | 508-854-2122
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Fax | 508-853-8593
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. STEPHEN J KERRIGAN
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Credential |
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Telephone | 508-854-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 4039
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License Number State | MA
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