1326145517 NPI number — ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, PC

Table of content: (NPI 1326145517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326145517 NPI number — ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, 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:
NEW ENGLAND PAIN MANAGEMENT CONSULTANTS
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:
1326145517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 414422
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:
02241-4422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-407-7713
Provider Business Mailing Address Fax Number:
781-407-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 CANTON ST
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
WESTWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02090-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-407-7713
Provider Business Practice Location Address Fax Number:
781-407-0998
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCIVOR
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
781-407-7713

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9764674 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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