| Online Care Group Pc | |
|
75 State St Fl 26 Boston MA 02109 | |
| (617) 204-3500 | |
| Not Available |
| Full Name | Online Care Group Pc |
|---|---|
| Speciality | General Practice |
| Location | 75 State St Fl 26, Boston, Massachusetts |
| Authorized Official Name and Position | Cynthia Horner (PRESIDENT) |
| Authorized Official Contact | 6172043500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Online Care Group Pc 75 State St Floor 26 Boston MA 02109-1827 Ph: () - | Online Care Group Pc 75 State St Fl 26 Boston MA 02109 Ph: (617) 204-3500 |
| NPI Number | 1962741322 |
|---|---|
| Provider Enumeration Date | 02/05/2013 |
| Last Update Date | 11/17/2021 |
| Medicare PECOS PAC ID | 9931426251 |
|---|---|
| Medicare Enrollment ID | O20150326000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962741322 | NPI | - | NPPES |
| Q008572 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Miia Lim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972526143 PECOS PAC ID: 9931370038 Enrollment ID: I20110921000678 |
| Provider Name | Sherri Lyn Dehaas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013900406 PECOS PAC ID: 0244217305 Enrollment ID: I20150326000645 |
| Provider Name | Mia Finkelston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447235171 PECOS PAC ID: 8224154430 Enrollment ID: I20150421000338 |
| Provider Name | Michael Gray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215931605 PECOS PAC ID: 6002887130 Enrollment ID: I20150421001194 |
| Provider Name | Lauralee Yalden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417142324 PECOS PAC ID: 9931299849 Enrollment ID: I20150501000355 |
| Provider Name | Kellie E Branch-dircks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255528204 PECOS PAC ID: 5991874257 Enrollment ID: I20150804003497 |
| Provider Name | Andrea L Gabel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881753713 PECOS PAC ID: 2163489071 Enrollment ID: I20150826000988 |
| Provider Name | Nicole S Boxer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003811589 PECOS PAC ID: 5890752638 Enrollment ID: I20151229000318 |
| Provider Name | Teresa Myers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508050899 PECOS PAC ID: 6406940238 Enrollment ID: I20160115001758 |
| Provider Name | Charles William Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780652792 PECOS PAC ID: 0941210314 Enrollment ID: I20161027002352 |
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