Basic Information
Provider Information
NPI: 1699212340
EntityType: 2
ReplacementNPI:  
OrganizationName: MASS GENERAL BRIGHAM URGENT CARE LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PARTNERS URGENT CARE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 399 REVOLUTION DR
Address2:  
City: SOMERVILLE
State: MA
PostalCode: 021451484
CountryCode: US
TelephoneNumber: 8889800505
FaxNumber:  
Practice Location
Address1: 137 STUART ST
Address2: SUITE A-7
City: BOSTON
State: MA
PostalCode: 021165609
CountryCode: US
TelephoneNumber: 8889800505
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/19/2017
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MULCAHY
AuthorizedOfficialFirstName: KEVIN
AuthorizedOfficialMiddleName: ROBERT
AuthorizedOfficialTitleorPosition: SENIOR DIRECTOR
AuthorizedOfficialTelephone: 6177249245
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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