EDWARD M. KENNEDY COMMUNITY HEALTH CENTER INC NPI 1013048347

NPI Information

NPI: 1013048347
Provider Name: EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC

Former Legal Business Name: GREAT BROOK VALLEY HEALTH CENTER, INC

Classification: Pharmacy - 3336C0002X
Entity Type: Organization

Specialization: Clinic Pharmacy

Address:
19 TACOMA ST
WORCESTER, MA
ZIP 01605
Phone: (508) 854-2128
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EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC is a clinic pharmacy pharmacy in Worcester, MA. The provider is a pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. EDWARD M. KENNEDY COMMUNITY HEALTH CENTER, INC NPI is 1013048347. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Great Brook Valley Health Center, Inc.

The provider's business location address is:

19 TACOMA ST
WORCESTER, MA
ZIP 01605-516
Phone: (508) 854-2128
Fax: (508) 595-1127

The provider's authorized official is Stephen J Kerrigan .
The authorized official title is President & Ceo and has the following contact phone number (508) 854-2122.

The enumeration date for this NPI number is 3/8/2007 and was last updated on 11/27/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3336C0002X	Pharmacy	Clinic Pharmacy	495	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0443891	MEDICAID	MASSACHUSETTS
2	110022061A	MEDICAID	MASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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