1376597104 NPI number — TOWN OF ACTON

Table of content: (NPI 1376597104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376597104 NPI number — TOWN OF ACTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF ACTON
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:
ACTON PUBLIC HEALTH NURSING SERVICE
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:
1376597104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
472 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-3952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-264-9653
Provider Business Mailing Address Fax Number:
978-264-4405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
472 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01720-3952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-264-9653
Provider Business Practice Location Address Fax Number:
978-264-4405
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVDOKIMOFF
Authorized Official First Name:
MERRILY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
978-264-9653

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120057 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300529 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0601918 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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