Basic Information
| Provider Information | |||||||||
| NPI: | 1316479660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAHEY PHYSICIAN COMMUNITY ORGANIZATION I INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 MALL RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 MAPLE ST. | ||||||||
| Address2: | LAHEY HEALTH URGENT CARE, DANVERS | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448085 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2017 | ||||||||
| LastUpdateDate: | 12/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | LONGWORTH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7817448097 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BETH ISRAEL LAHEY HEALTH INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/23/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.