1518982313 NPI number — STURDY MEMORIAL ASSOCIATES, INC.

Table of content: (NPI 1518982313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518982313 NPI number — STURDY MEMORIAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STURDY MEMORIAL ASSOCIATES, 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:
FOXBORO CENTER FOR WOMEN'S & FAMILY HEALTH
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:
1518982313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOXBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-698-5350
Provider Business Mailing Address Fax Number:
508-698-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOXBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-698-5350
Provider Business Practice Location Address Fax Number:
508-698-5373
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHYAVITZ
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
508-236-8000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9778454 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17147 . This is a "MABC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 615273 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 37452 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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