| Renaissance Primary Care, Llc | |
|
11-15 Sandersdale Road Southbridge MA 01550 | |
| (774) 420-2311 | |
| (508) 519-0763 |
| Full Name | Renaissance Primary Care, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11-15 Sandersdale Road, Southbridge, Massachusetts |
| Authorized Official Name and Position | James Manuel (PSYCHOLOGIST) |
| Authorized Official Contact | 7744202311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Primary Care, Llc 11-15 Sandersdale Road Southbridge MA 01550 Ph: (774) 420-2311 | Renaissance Primary Care, Llc 11-15 Sandersdale Road Southbridge MA 01550 Ph: (774) 420-2311 |
| NPI Number | 1649729021 |
|---|---|
| Provider Enumeration Date | 09/27/2016 |
| Last Update Date | 08/01/2023 |
| Certification Date | 07/28/2023 |
| Medicare PECOS PAC ID | 3476832379 |
|---|---|
| Medicare Enrollment ID | O20161117000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649729021 | NPI | - | NPPES |
| Provider Name | Malcolm R Freedman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679655245 PECOS PAC ID: 7113902917 Enrollment ID: I20040623001484 |
| Provider Name | Adekunle G Fajana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396727806 PECOS PAC ID: 2365480498 Enrollment ID: I20050420000271 |
| Provider Name | Maria S Arrubla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881708394 PECOS PAC ID: 9335287671 Enrollment ID: I20091106000490 |
| Provider Name | Alex G Morales Perez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104110774 PECOS PAC ID: 6901109289 Enrollment ID: I20160120001018 |
| Provider Name | Thyra Gutierrez-sierra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982962916 PECOS PAC ID: 2668776600 Enrollment ID: I20160211000646 |
| Provider Name | Arnaldo R Cruz Igartua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013110899 PECOS PAC ID: 5496011330 Enrollment ID: I20171109002655 |
| Provider Name | Christine Surrette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689160954 PECOS PAC ID: 9234492307 Enrollment ID: I20181019002335 |
| Provider Name | James W Manuel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982849352 PECOS PAC ID: 8325171036 Enrollment ID: I20190822001258 |
| Provider Name | Yonide Lareche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639535073 PECOS PAC ID: 1254662141 Enrollment ID: I20191007003333 |
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