1174524276 NPI number — CITY OF AMESBURY

Table of content: LIA ELIZABETH KING RRT (NPI 1417275025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174524276 NPI number — CITY OF AMESBURY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF AMESBURY
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:
6
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:
1174524276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 986500, DEPT 2050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02298-6500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-492-8484
Provider Business Mailing Address Fax Number:
617-492-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMESBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01913-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-388-8185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BERKENBUSH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
978-388-8185

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3052 , 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: 590008830 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 014859 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 800594 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701404 . This is a "HARBARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 014859 . This is a "MASS MEDEX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1705334 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009094 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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