Organization
DIMOCK COMMUNITY HEALTH CENTER
Active
Organization
DIMOCK COMMUNITY HEALTH CENTER
Active
Other names
The Dimock Center
Organization subpart
No
Provider details
NPI number
Authorized official
KERLLEY AIME' (CREDENTIALING COORDINATOR)
(617) 442-8800
Entity
Organization
Contact information
Practice address
55 DIMOCK ST, CREDENTIALING OFFICE, ROXBURY, MA 02119-1029
(617) 442-8800
(617) 427-2784
Mailing address
55 DIMOCK ST, CREDENTIALING OFFICE, ROXBURY, MA 02119-1029
(617) 442-8800
(617) 427-2784
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M21066
MEDICARE PTAN
MA
Enumeration date
02/14/2014
Last updated
02/14/2014
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