Provider Demographics
NPI:1033145297
Name:CARITAS VALLEY REGIONAL MEDICAL SERVICES CORP
Entity Type:Organization
Organization Name:CARITAS VALLEY REGIONAL MEDICAL SERVICES CORP
Other - Org Name:BRANCH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-327-5410
Mailing Address - Street 1:9 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1955
Mailing Address - Country:US
Mailing Address - Phone:978-683-9177
Mailing Address - Fax:978-688-8679
Practice Address - Street 1:9 BRANCH ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1955
Practice Address - Country:US
Practice Address - Phone:978-683-9177
Practice Address - Fax:978-688-8679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARITAS VALLEY REGIONAL MEDICAL SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779086Medicaid
MA604043OtherTUFTS HEALTH PLAN
MAM19186OtherBC/BS OF MA
MAM19186OtherBC/BS OF MA