Provider Demographics
NPI:1164993291
Name:WORCESTER PHYSICIANS AND NURSES SERVICES LLC
Entity Type:Organization
Organization Name:WORCESTER PHYSICIANS AND NURSES SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIDIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-556-1072
Mailing Address - Street 1:100 GROVE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2627
Mailing Address - Country:US
Mailing Address - Phone:508-556-1072
Mailing Address - Fax:
Practice Address - Street 1:100 GROVE ST STE 210
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2627
Practice Address - Country:US
Practice Address - Phone:508-556-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty