1538273297 NPI number — PAMELA HIBBARD BUGBEE OTRL

Table of content: PAMELA HIBBARD BUGBEE OTRL (NPI 1538273297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538273297 NPI number — PAMELA HIBBARD BUGBEE OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUGBEE
Provider First Name:
PAMELA
Provider Middle Name:
HIBBARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

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:
1538273297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 NEPONSET ST FL ST2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01606-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-9510
Provider Business Mailing Address Fax Number:
508-853-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 GOLD STAR BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-856-9510
Provider Business Practice Location Address Fax Number:
508-853-1907
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2490 , 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: 042477266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "HEALTHCARE VALUE MANAGEME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701335 . This is a "WELFARE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2779432 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 787398 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA4053 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7551642 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42392 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: OT0068 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701335 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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