Basic Information
| Provider Information | |||||||||
| NPI: | 1609387695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASS GENERAL BRIGHAM URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 399 REVOLUTION DR | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021451484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889800505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1815 MASSACHUSETTS AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021401430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8578565770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2017 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | MULCAHY | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6177249245 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MASS GENERAL BRIGHAM URGENT CARE LLC | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.