1447395694 NPI number — MASS BAY ENTERPRISES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447395694 NPI number — MASS BAY ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASS BAY ENTERPRISES LLC
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:
1447395694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 EASTMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH EASTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02375-1279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-238-5766
Provider Business Mailing Address Fax Number:
508-238-8045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 EASTMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02375-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-238-5766
Provider Business Practice Location Address Fax Number:
508-238-8045
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCQUINN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
EVELYN
Authorized Official Title or Position:
PRACTICE DIRECTOR
Authorized Official Telephone Number:
508-238-5766

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6202 , 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)





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