1558359992 NPI number — TOWN OF WALLINGFORD

Table of content: (NPI 1558359992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558359992 NPI number — TOWN OF WALLINGFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WALLINGFORD
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:
WALLINGFORD DEPT. OF FIRE SVS
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:
1558359992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 TURCOTTE MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01969-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-488-4351
Provider Business Mailing Address Fax Number:
978-356-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MASONIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLINGFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06492-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-294-2730
Provider Business Practice Location Address Fax Number:
203-294-2736
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEIDGERD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
203-294-2730

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  L148P1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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