Provider Demographics
NPI:1689918682
Name:SHRIVER CLINICAL SERVICES
Entity Type:Organization
Organization Name:SHRIVER CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:CHARLY
Authorized Official - Last Name:DARIUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:781-718-0900
Mailing Address - Street 1:131 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1902
Mailing Address - Country:US
Mailing Address - Phone:781-279-1260
Mailing Address - Fax:781-279-4400
Practice Address - Street 1:131 EMERALD ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1902
Practice Address - Country:US
Practice Address - Phone:781-279-1260
Practice Address - Fax:781-279-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare