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RENAISSANCE PRIMARY CARE LLC NPI 1649729021


NPI Information

NPI: 1649729021
Provider Name: RENAISSANCE PRIMARY CARE, LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 22D2121440

Address:
11-15 SANDERSDALE ROAD
SOUTHBRIDGE, MA
ZIP 01550
Phone: (774) 420-2311
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RENAISSANCE PRIMARY CARE, LLC is an internal medicine in Southbridge, MA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. RENAISSANCE PRIMARY CARE, LLC NPI is 1649729021. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11-15 SANDERSDALE ROAD
SOUTHBRIDGE, MA
ZIP 01550
Phone: (774) 420-2311
Fax: (508) 519-0763

The provider's authorized official is James Manuel .
The authorized official title is Psychologist and has the following contact phone number (774) 420-2311.

The CLIA number assigned to this NPI record is 22D2121440 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/27/2016 and was last updated on 8/1/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YM0800XCounselorMental HealthNo
2103T00000XPsychologistNo
32084P0800XPsychiatry & NeurologyPsychiatryNo
4261QP2300XClinic/CenterPrimary CareNo
5207R00000XInternal MedicineYes

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.