Provider Demographics
NPI:1669401832
Name:ANGELS PIONEER MEDICAL CENTERS, PC
Entity type:Organization
Organization Name:ANGELS PIONEER MEDICAL CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. OP. MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-871-3773
Mailing Address - Street 1:10 N MAIN ST
Mailing Address - Street 2:3 RD FLOOR
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2130
Mailing Address - Country:US
Mailing Address - Phone:508-678-0943
Mailing Address - Fax:508-678-1213
Practice Address - Street 1:536 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2424
Practice Address - Country:US
Practice Address - Phone:781-871-3773
Practice Address - Fax:781-871-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21641Medicare ID - Type UnspecifiedGROUP NUMBER