1558412874 NPI number — TOWNE MEDICAL SUPPLY, INC.

Table of content: (NPI 1558412874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558412874 NPI number — TOWNE MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWNE MEDICAL SUPPLY, 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:
1558412874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 BOSTON TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-757-7048
Provider Business Mailing Address Fax Number:
508-754-4603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 BOSTON TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01545-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-757-7048
Provider Business Practice Location Address Fax Number:
508-754-4603
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROZAK
Authorized Official First Name:
MARY FRANCES
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESDENT
Authorized Official Telephone Number:
508-757-7048

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0415057 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 436990 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 700552 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2590 . This is a "FALLON COMMUNITY HEALTH P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 157954 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 800534 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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