Organization
SECON OF NEW ENGLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SYLVIA LYNN FREEMAN (MGR OF CREDENTIALING/ENROLLMENT)
(508) 304-7602
Entity
Organization
Contact information
Practice address
415 MAIN ST, STE 4, WORCESTER, MA 01608-1706
(508) 831-0703
(508) 831-0803
Mailing address
PO BOX 830525, #OWC 30, BIRMINGHAM, AL 35283-0525
(508) 304-7602
(508) 304-7602
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
2465
MA
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000027970
—
MA
01
—
0007640552
AETNA PIN
—
05
—
0816931
—
MA
05
—
200024710A
—
OK
05
—
30803284
—
NH
01
—
41933
FALLON PIN
MA
05
—
4401024
—
TN
01
—
691566
TUFTS HEALTH
—
01
—
TR0084
BLUE CROSS BLUE SHIELD
—
Enumeration date
06/15/2005
Last updated
03/06/2023
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