Kathleen Elaine Vickers I

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

S90889172 Issued in MA

Practice address

1005 Main St
Fitchburg, MA 01420-3179

Phone

(160) 347-5519

NPI assigned

Jun 11, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1043888514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAIN ST",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014203179",
            "telephone_number": "160-347-5519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAIN ST",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014203179",
            "telephone_number": "160-347-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERS",
        "first_name": "KATHLEEN",
        "middle_name": "ELAINE",
        "name_suffix": "I",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MA",
            "license": "S90889172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2HC9-X05-FV36",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Methadone Clinic in Fitchburg, MA
• Providers in Fitchburg, MA by specialty
• Methadone Clinic in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.