Provider Demographics
NPI:1295063626
Name:PLYMOUTH CARVER PRIMARY CARE
Entity type:Organization
Organization Name:PLYMOUTH CARVER PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:ANP- BC
Authorized Official - Phone:508-746-7272
Mailing Address - Street 1:110 LONG POND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:508-746-7272
Mailing Address - Fax:508-746-0104
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-7272
Practice Address - Fax:508-746-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty