Basic Information
| Provider Information | |||||||||
| NPI: | 1740262450 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WINCHESTER PHYSICIAN ASSOCIATES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | WINCHESTER HOSPTIAL URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 760 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018904260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817567273 | ||||||||
| FaxNumber: | 7817567274 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SALEM ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018871200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789886000 | ||||||||
| FaxNumber: | 9786574169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILLS | ||||||||
| AuthorizedOfficialFirstName: | EILEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7817567273 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WINCHESTER PHYSICIAN ASSOCIATES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 49082 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 49276 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 39213 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 32965 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 55154 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 51661 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9777229 | 05 | MA | MEDICAID |