Provider Demographics
NPI:1144575093
Name:SIMMONS COLLEGE HEALTH CENTER
Entity Type:Organization
Organization Name:SIMMONS COLLEGE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-521-1020
Mailing Address - Street 1:94 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4127
Mailing Address - Country:US
Mailing Address - Phone:617-521-1020
Mailing Address - Fax:
Practice Address - Street 1:94 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4127
Practice Address - Country:US
Practice Address - Phone:617-521-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMMONS COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service