Provider Demographics
NPI:1508164583
Name:WACHUSETT EMERGENCY PHYSICIANS, PC
Entity Type:Organization
Organization Name:WACHUSETT EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-466-2428
Mailing Address - Street 1:60 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2205
Mailing Address - Country:US
Mailing Address - Phone:978-466-2994
Mailing Address - Fax:978-466-2993
Practice Address - Street 1:275 NICHOLS RD
Practice Address - Street 2:BURBANK URGENT CARE CENTER
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-1919
Practice Address - Country:US
Practice Address - Phone:978-343-5074
Practice Address - Fax:978-343-5418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WACHUSETT EMERGENCY PHYSICIANS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA601212OtherHPHC
MA703641OtherTUFTS
MA9749144Medicaid
MAM14339OtherBLUE CROSS
MA601212OtherHPHC