1619979796 NPI number — TOWN OF ANDOVER

Table of content: (NPI 1619979796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619979796 NPI number — TOWN OF ANDOVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF ANDOVER
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:
ANDOVER FIRE DEPARTMENT
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:
1619979796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 NORFOLK AVENUE
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:
02375-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-297-2068
Provider Business Mailing Address Fax Number:
508-297-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01810-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-475-1281
Provider Business Practice Location Address Fax Number:
978-475-6654
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANSFIELD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BRENDAN
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
978-475-1281

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3056 , 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: 1700871 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000028099 . This is a "BMC HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 016059 . This is a "MASS MEDEX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 103474100 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008794 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10694 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 016059 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 590011162 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 700591 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 801595 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 155028XX . This is a "PREFERRED CARE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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