| Leominster Primary Care LLC | |
|
50 Memorial Drive Ste 210 Leominster MA 01453-2238 | |
| (978) 514-8704 | |
| (978) 514-8705 |
| Full Name | Leominster Primary Care LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 50 Memorial Drive, Leominster, Massachusetts |
| Authorized Official Name and Position | Stephanie M Child (OFFICE MANAGER) |
| Authorized Official Contact | 9784072476 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leominster Primary Care LLC 50 Memorial Drive Ste 210 Leominster MA 01453-2238 Ph: (978) 514-8704 | Leominster Primary Care LLC 50 Memorial Drive Ste 210 Leominster MA 01453-2238 Ph: (978) 514-8704 |
| NPI Number | 1952069874 |
|---|---|
| Provider Enumeration Date | 12/08/2021 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Medicare PECOS PAC ID | 0648781708 |
|---|---|
| Medicare Enrollment ID | O20250616002321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952069874 | NPI | - | NPPES |
| 110049609A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Stephen Towle Child |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1790747442 PECOS PAC ID: 6800856485 Enrollment ID: I20250616002441 |
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