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General NPI Number Information
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NPI Number | 1952069874
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Entity Type | Organization
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Legal Business Name | LEOMINSTER PRIMARY CARE LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 50 MEMORIAL DRIVE STE 210
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-514-8704
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Fax | 978-514-8705
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Provider Business Mailing Address
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Address Line | 50 MEMORIAL DRIVE STE 210
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-514-8704
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Fax | 978-514-8705
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE M CHILD
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Credential |
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Telephone | 978-407-2476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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