1306870639 NPI number — WILKERSON & GOLDEN PHYSICAL THERAPY ASSOCIATES PC

Table of content: (NPI 1306870639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306870639 NPI number — WILKERSON & GOLDEN PHYSICAL THERAPY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKERSON & GOLDEN PHYSICAL THERAPY ASSOCIATES PC
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:
1306870639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BURNHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURNERS FALLS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01376-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-774-7988
Provider Business Mailing Address Fax Number:
413-773-7322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 BURNHAM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURNERS FALLS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01376-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-774-7988
Provider Business Practice Location Address Fax Number:
413-773-7322
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-774-7988

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0041972 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: WIY65604 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 618324 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9759174 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000038815 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 626000 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17742 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: CM8506 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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