Provider Demographics
NPI:1801021951
Name:COORDINATED PRIMARY CARE, INC
Entity Type:Organization
Organization Name:COORDINATED PRIMARY CARE, INC
Other - Org Name:CPC SOUTH LEOMINSTER FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FABELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-466-4243
Mailing Address - Street 1:1069 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4805
Mailing Address - Country:US
Mailing Address - Phone:978-534-3500
Mailing Address - Fax:978-466-6307
Practice Address - Street 1:1069 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4805
Practice Address - Country:US
Practice Address - Phone:978-534-3500
Practice Address - Fax:978-466-6307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COORDINATED PRIMARY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-19
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20928Medicare PIN