1508990813 NPI number — SPENCER RESCUE & EMERGENCY SQUAD, INC.

Table of content: (NPI 1508990813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508990813 NPI number — SPENCER RESCUE & EMERGENCY SQUAD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPENCER RESCUE & EMERGENCY SQUAD, 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:
1508990813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 BIXBY RD
Provider Second Line Business Mailing Address:
P.O. BOX 147
Provider Business Mailing Address City Name:
SPENCER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01562-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-885-4476
Provider Business Mailing Address Fax Number:
508-885-0315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MAIN ST STE 2K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUTTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01590-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-476-9740
Provider Business Practice Location Address Fax Number:
508-476-9748
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUTER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
508-885-4476

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3308 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000005959 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1700847 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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