Provider Demographics
NPI:1932942869
Name:CONVENIENTMD - FFS UC LLC
Entity type:Organization
Organization Name:CONVENIENTMD - FFS UC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REVENUE CYCLE MGT
Authorized Official - Prefix:
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSONNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-410-6700
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:1285 BELMONT ST STE 1
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4440
Practice Address - Country:US
Practice Address - Phone:508-894-7015
Practice Address - Fax:508-894-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care