1194724435 NPI number — TOWN OF WILBRAHAM

Table of content: (NPI 1194724435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194724435 NPI number — TOWN OF WILBRAHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WILBRAHAM
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:
WILBRAHAM FIRE DEPARTMENT EMERGENCY AMBULANCE SERVICE
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:
1194724435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2770 BOSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILBRAHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01095-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-596-3122
Provider Business Mailing Address Fax Number:
413-596-2632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 BOSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBRAHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01095-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-596-3122
Provider Business Practice Location Address Fax Number:
413-596-2632
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NOTHE
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
413-596-3916

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3964 , 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: 012459 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000022474 . This is a "BMC HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1714945 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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