Provider Demographics
NPI: | 1255051850 |
---|---|
Name: | GATHER HEALTH PRIMARY CARE OF MASSACHUSETTS PC |
Entity type: | Organization |
Organization Name: | GATHER HEALTH PRIMARY CARE OF MASSACHUSETTS PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | INCORPORATOR &CHIEF MEDICAL OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LOUGHNANE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 857-544-1097 |
Mailing Address - Street 1: | 744 E SQUANTUM ST |
Mailing Address - Street 2: | |
Mailing Address - City: | QUINCY |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02171-1253 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-820-5968 |
Mailing Address - Fax: | 833-471-5603 |
Practice Address - Street 1: | 205 PARKINGWAY |
Practice Address - Street 2: | |
Practice Address - City: | QUINCY |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02169 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-820-5968 |
Practice Address - Fax: | 833-471-5603 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-09-01 |
Last Update Date: | 2024-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |