1457351306 NPI number — ANDOVER VOLUNTEER FIRE DEPARTMENT, INC.

Table of content: (NPI 1457351306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457351306 NPI number — ANDOVER VOLUNTEER FIRE DEPARTMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDOVER VOLUNTEER FIRE DEPARTMENT, INC.
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:
1457351306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06232-1556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-742-7477
Provider Business Mailing Address Fax Number:
860-742-4047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06232-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-742-7477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HEGENER
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CHIEF
Authorized Official Telephone Number:
860-742-7477

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004235835 . This is a "COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 710C001B1CT01 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004235835 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004235835 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".