Provider Demographics
NPI:1215323407
Name:WOONSOCKET URGENT CARE PC
Entity type:Organization
Organization Name:WOONSOCKET URGENT CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLERA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:781-255-0500
Mailing Address - Street 1:40 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4445
Mailing Address - Country:US
Mailing Address - Phone:781-255-0500
Mailing Address - Fax:
Practice Address - Street 1:40 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4445
Practice Address - Country:US
Practice Address - Phone:781-255-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOONSOCKET URGENT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-14
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074292BMedicaid
MA709004964Medicare PIN
MAP13237Medicare UPIN