1235300377 NPI number — FAIRVIEW HOSPITAL DIALYSIS CENTER

Table of content: (NPI 1235300377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235300377 NPI number — FAIRVIEW HOSPITAL DIALYSIS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW HOSPITAL DIALYSIS CENTER
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:
Provider Other Organization Name Type Code:
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:
1235300377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01202-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-447-2000
Provider Business Mailing Address Fax Number:
413-447-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-854-9910
Provider Business Practice Location Address Fax Number:
413-854-9911
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RODOWICZ
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
413-447-2000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  2052 , 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: 0373 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1200542 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20850 . This is a "BMC HEALTH NET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900245 . This is a "TUFTS HEALTH PLAN OUTPT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 221302 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6300460 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10005803 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2222003801 . This is a "BLUE CROSS INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900038 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: HO4359 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 905627 . This is a "TUFTS HEALTH PLAN INPT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1001728 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12257 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222003830 . This is a "BLUE CROSS SDC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222003810 . This is a "BLUE CROSS OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 992756 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 220038 . This is a "UNICARE MA EMPLOYEE GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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