Provider Demographics
NPI:1851623714
Name:COORDINATED PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:COORDINATED PRIMARY CARE, INC.
Other - Org Name:HEALTHALLIANCE PEDIATRIC HOSPITALISTS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC 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:978-466-4268
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:978-466-2257
Mailing Address - Fax:978-466-2291
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-466-2257
Practice Address - Fax:978-466-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072006AMedicaid
MAM20928OtherMEDICARE GROUP NUMBER