MEDICARE: UPHAM'S CORNER HEALTH COMMITTEE, 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
1	261QD0000X	Dental Clinic/Center
2	261QF0050X	Non-Surgical Family Planning Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)	490	MA
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM2500X	Medical Specialty Clinic/Center
6	261QP1100X	Podiatric Clinic/Center
7	261QP2300X	Primary Care Clinic/Center
8	261QU0200X	Urgent Care Clinic/Center
9	291U00000X	Clinical Medical Laboratory
10	292200000X	Dental Laboratory
11	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780780486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPHAM'S CORNER HEALTH COMMITTEE, INC.

Provider Business Mailing Address
First Line	:	500 COLUMBIA RD
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02125-2322
Country	:	US
Telephone Number	:	617-287-8000
Fax Number	:	617-282-8625

Provider Business Practice Location Address
First Line	:	500 COLUMBIA RD
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02125-2322
Country	:	US
Telephone Number	:	617-287-8000
Fax Number	:	617-282-8625

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAGDEEP TRIVEDI
Credential	:
Telephone Number	:	617-740-8131

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/12/2017

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Directions to “UPHAM'S CORNER HEALTH COMMITTEE, INC. ” Practice Location

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