Provider Demographics
NPI:1295806636
Name:O'NEILL HEALTH CLINIC, INC.
Entity type:Organization
Organization Name:O'NEILL HEALTH CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-771-9599
Mailing Address - Street 1:61 BRANT WAY
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2162
Mailing Address - Country:US
Mailing Address - Phone:508-776-2656
Mailing Address - Fax:508-790-4858
Practice Address - Street 1:105 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5205
Practice Address - Country:US
Practice Address - Phone:508-771-1218
Practice Address - Fax:508-771-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113425251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1588616742OtherNATIONAL PROVIDER ID
MAM20795Medicare ID - Type Unspecified
MAP30164Medicare ID - Type Unspecified