1326488115 NPI number — PHONEDOCTORX, LLC.

Table of content: (NPI 1326488115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326488115 NPI number — PHONEDOCTORX, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHONEDOCTORX, LLC.
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:
1326488115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MILL RD
Provider Second Line Business Mailing Address:
SUITE 350 B
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-999-3133
Provider Business Mailing Address Fax Number:
508-999-3533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 MILL RD
Provider Second Line Business Practice Location Address:
SUITE 350 B
Provider Business Practice Location Address City Name:
FAIRHAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02719-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-999-3133
Provider Business Practice Location Address Fax Number:
508-999-3533
Provider Enumeration Date:
06/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPIRITO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
508-999-3133

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  43492 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 59251 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 47496 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 53803 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 43920 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 150105 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 231610 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 224456 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 229250 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 241692 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 36492 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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