Provider Demographics
NPI:1427436625
Name:HEALTH CLINIC INC
Entity type:Organization
Organization Name:HEALTH CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OF. MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-679-0010
Mailing Address - Street 1:429 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-4231
Mailing Address - Country:US
Mailing Address - Phone:508-679-0010
Mailing Address - Fax:508-672-4679
Practice Address - Street 1:1155 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6634
Practice Address - Country:US
Practice Address - Phone:508-997-2900
Practice Address - Fax:508-991-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067720AMedicaid
D82905Medicare UPIN
MA110067720AMedicaid