Provider Demographics
NPI:1750309431
Name:FAMILY MEDICINE ASSOCIATES OF SOUTH ATTLEBORO, P.C.
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF SOUTH ATTLEBORO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-761-5650
Mailing Address - Street 1:562 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6942
Mailing Address - Country:US
Mailing Address - Phone:508-761-5650
Mailing Address - Fax:508-761-9870
Practice Address - Street 1:562 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6942
Practice Address - Country:US
Practice Address - Phone:508-761-5650
Practice Address - Fax:508-761-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
601525OtherTUFTS
MAM17607OtherMASS BC/BS
MA0021726OtherNEIGHBORHOOD HEALTH PLAN
MA48340OtherFALLON COMMUNITY
MA000000022845OtherBMC HEALTHNET
MA9704361Medicaid
MA=========OtherHEALTH CARE NEW ENGLAND
MA=========OtherHEALTH CARE NEW ENGLAND