1538194824 NPI number — STURDY MEMORIAL ASSOCIATES, INC.

Table of content: (NPI 1538194824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538194824 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:
STURDY CARDIOLOGY ASSOCIATES
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:
1538194824
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:
2 HAYWARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703-2113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-431-3600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 HAYWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-431-3600
Provider Business Practice Location Address Fax Number:
508-431-2545
Provider Enumeration Date:
07/12/2006

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: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3511 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9772561 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 688516 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17747 . This is a "MABC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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