| NPI | 1003607193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA FARRELL Medical Policy Specialist 617-470-2541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| 302R00000X Health Maintenance Organization | |
| 305S00000X Point of Service | |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |