1053365981 NPI number — TOWN OF LEXINGTON

Table of content: (NPI 1053365981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053365981 NPI number — TOWN OF LEXINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF LEXINGTON
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:
1053365981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4110, DEPT 1800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01888-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-682-1840
Provider Business Mailing Address Fax Number:
617-492-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 BEDFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02420-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-698-4605
Provider Business Practice Location Address Fax Number:
781-861-2791
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENCABAUGH
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
781-698-4605

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1703366 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015459 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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