Imedical365 Inc
Organization Active NPI Primary Care Clinic/Center · Avon, MA
NPI 1760074256 · NPPES record last updated Mar 17, 2021
Key facts
- NPI
- 1760074256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- IMEDICAL365 INC
- Practice address
- 249 W Main St
Avon, MA 02322-1330 - Phone
- (508) 326-0493
- NPI assigned
- Feb 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Mr. Joel Clerville, NP
- Title
- President
- Phone
- (508) 326-0496
Corporate family (same tax ID) 1
Practitioners 4
-
Marie-Helene Almonor, M.D.
-
Joel Clerville, NP
-
Sameh A Mesallum, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210319000213 | MA | Part B Supplier - Clinic/Group Practice | 1557778529 |
Receives reassigned benefits from 2 practitioners Practice locations: Avon, MA; Brockton, MA |
National Provider Directory
- Tax ID family
- Imedical365 Inc
Locations
249 W Main St
Avon, MA 02322
Phone (508) 326-0493
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
249 W Main St
Avon, MA 02322-1330
Mailing address
PO Box 1911
Brockton, MA 02303-1911
Phone (508) 326-0496
Other providers in Avon, MA
- Grow-Associates, Inc.
- Healthpro Training and Placement Services
- Home Health and Child Care Services, Inc.
- Hope Adult Group Home
- Imedical365 Inc
- Intersect Clinical Services, LLC
- Rachel Blanchette Jalles
- JC Precious Minds Psychiatry LLC
- Herold Jerome
- Joseph D. Emma, M.D. & Associates, P.C.
All providers in Avon, MA · Primary Care Clinic/Center in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.