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NPI Code Detail

MEDICARE: EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC

MEDICARE: EDWARD M. KENNEDY 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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1700567021
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC
Provider Business Mailing Address
First Line : 115 NE CUTOFF STE 200
Second Line :
City : WORCESTER
State : MA
Zip : 01606-1224
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 41 CAPE RD
Second Line :
City : MILFORD
State : MA
Zip : 01757-3276
Country : US
Telephone Number : 508-270-5744
Fax Number :
Authorized Official
Title or Position : VP HR
Name : DAVID SMALL
Credential :
Telephone Number : 508-532-7315
Provider Enumeration Date : 07/28/2023
Last Update Date : 07/28/2023

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