1821035619 NPI number — TOWN OF BARRE

Table of content: (NPI 1821035619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821035619 NPI number — TOWN OF BARRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BARRE
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:
TOWN OF BARRE
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:
1821035619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WEST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01005-9290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-355-2504
Provider Business Mailing Address Fax Number:
978-355-5023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01005-9257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-688-7730
Provider Business Practice Location Address Fax Number:
978-355-6152
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FULLAM
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
EMS ADMINISTRATOR
Authorized Official Telephone Number:
508-688-7730

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 3262 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 042559 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701294 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 802659 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1712381 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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