Provider Demographics
NPI:1487659694
Name:SECON OF NEW ENGLAND LLC
Entity Type:Organization
Organization Name:SECON OF NEW ENGLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR OF CREDENTIALING/ENROLLMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-304-7602
Mailing Address - Street 1:PO BOX 830525
Mailing Address - Street 2:#OWC 30
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0525
Mailing Address - Country:US
Mailing Address - Phone:508-304-7602
Mailing Address - Fax:508-304-7602
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1706
Practice Address - Country:US
Practice Address - Phone:508-831-0703
Practice Address - Fax:508-831-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2465291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007640552OtherAETNA PIN
OK200024710AMedicaid
MA41933OtherFALLON PIN
TR0084OtherBLUE CROSS BLUE SHIELD
TN4401024Medicaid
691566OtherTUFTS HEALTH
MA0816931Medicaid
MA000000027970Medicaid
NH30803284Medicaid
TN4401024Medicaid
MA000000027970Medicaid
MA0032468Medicare PIN