Provider Demographics
NPI:1780039966
Name:WOONSOCKET URGENT CARE PC
Entity Type:Organization
Organization Name:WOONSOCKET URGENT CARE PC
Other - Org Name:NATICK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLERA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:781-255-0500
Mailing Address - Street 1:1210 BOSTON PROVIDENCE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5061
Mailing Address - Country:US
Mailing Address - Phone:781-255-0500
Mailing Address - Fax:781-255-0400
Practice Address - Street 1:2-4 MERCER RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2415
Practice Address - Country:US
Practice Address - Phone:508-318-4466
Practice Address - Fax:508-647-2789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOONSOCKET URGENT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
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
MA709004964Medicare PIN
MA110074292BMedicaid