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General NPI Number Information
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NPI Number | 1780780486
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Entity Type | Organization
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Legal Business Name | UPHAM'S CORNER HEALTH COMMITTEE, INC.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 500 COLUMBIA RD
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City | DORCHESTER
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State | MA
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Zip | 02125-2322
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Country | US
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Telephone | 617-287-8000
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Fax | 617-282-8625
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Provider Business Mailing Address
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Address Line | 500 COLUMBIA RD
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City | DORCHESTER
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State | MA
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Zip | 02125-2322
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Country | US
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Telephone | 617-287-8000
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Fax | 617-282-8625
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Authorized Official
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Title or Position | CEO
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Name | MR. JAGDEEP TRIVEDI
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Credential |
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Telephone | 617-740-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental 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 | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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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 | 490
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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