Provider Demographics
NPI:1437628385
Name:WOONSOCKET URGENT CARE, PC
Entity Type:Organization
Organization Name:WOONSOCKET URGENT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-255-0500
Mailing Address - Street 1:4 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2455
Mailing Address - Country:US
Mailing Address - Phone:508-318-4466
Mailing Address - Fax:505-545-1445
Practice Address - Street 1:1 WRENTHAM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-2532
Practice Address - Country:US
Practice Address - Phone:508-318-4466
Practice Address - Fax:508-545-1445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOONSOCKET URGENT CARE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074292BMedicaid
MAP13237OtherMEDICARE UPIN
MA709004964OtherMEDICARE PIN