1831189380 NPI number — TOWN OF MANSFIELD

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 1831189380 NPI number — TOWN OF MANSFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF MANSFIELD
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:
1831189380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 290184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06129-0184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-257-9201
Provider Business Mailing Address Fax Number:
860-721-6362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 S EAGLEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORRS MANSFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06268-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-429-5290
Provider Business Practice Location Address Fax Number:
860-429-3233
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GENTILE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
AUTHORIZED AGENT
Authorized Official Telephone Number:
860-257-9201

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  C078B3 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004173209 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590011509 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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