Organization Name: | WELLESLEY HILLS PCMH |
NPI Number: | 1073856076 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW JASON DUPEE (PRESIDENT) |
Mailing Address: | 65 Walnut St Suite 440 Wellesley |
State: | MA US |
Postal Code: | 024812118 |
Phone Number: | 7812359089 |
Fax Number: | 7812375121 |
NPI Enumeration Date: | 03/28/2013 |
NPI Last Update Date: | 03/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |