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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
1261QF0400XFederally Qualified Health Center (FQHC)4039MA

Other Identifiers

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

General Provider Information

NPI Number : 1992137426
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 : 508-854-2122
Fax Number : 508-853-8593
Provider Business Practice Location Address
First Line : 41 CAPE RD
Second Line :
City : MILFORD
State : MA
Zip : 01757-3276
Country : US
Telephone Number : 800-853-2288
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. STEPHEN J KERRIGAN
Credential :
Telephone Number : 508-854-2122
Provider Enumeration Date : 08/07/2013
Last Update Date : 05/28/2024

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