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NPI Code Detail

MEDICARE: SOUTH END COMMUNITY HEALTH CENTER INC

MEDICARE: SOUTH END COMMUNITY HEALTH CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1619927233
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH END COMMUNITY HEALTH CENTER INC
Provider Business Mailing Address
First Line : 1601 WASHINGTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02118-1951
Country : US
Telephone Number : 617-425-2000
Fax Number : 617-424-8725
Provider Business Practice Location Address
First Line : 1601 WASHINGTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02118-1951
Country : US
Telephone Number : 617-425-2000
Fax Number : 617-424-8725
Authorized Official
Title or Position : CEO
Name : WILLIAM WALCZAK
Credential :
Telephone Number : 617-425-2000
Provider Enumeration Date : 05/12/2006
Last Update Date : 04/29/2019

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Directions to “SOUTH END COMMUNITY HEALTH CENTER INC ” Practice Location

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