1164427431 NPI number — ESSENT HEALTHCARE - AYER, INC.

Table of content: (NPI 1164427431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164427431 NPI number — ESSENT HEALTHCARE - AYER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESSENT HEALTHCARE - AYER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NASHOBA VALLEY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164427431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GROTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AYER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01432-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-784-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GROTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AYER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01432-1168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-784-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REIMBURSEMENT
Authorized Official Telephone Number:
615-312-5106

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2298 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2222009810 . This is a "BLUE CROSS OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222009801 . This is a "BLUE CROSS INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M21244 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 903837 . This is a "HARVARD PILGRIM HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136598CF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 974225 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 982010 . This is a "TUFTS OUTPATIENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001311 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1213270 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6300130 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 982011 . This is a "TUFTS INPATIENT" identifier . This identifiers is of the category "OTHER".




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