1639269624 NPI number — BIG Y FOODS INC

Table of content: DR. RONALD WAYNE STOUT MD (NPI 1992042899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639269624 NPI number — BIG Y FOODS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG Y FOODS 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:
6
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:
1639269624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 WILLIMANSETT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HADLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 WILLIMANSETT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-538-6178
Provider Business Practice Location Address Fax Number:
413-538-7462
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAPPAS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY OPERATIONS MANAGER
Authorized Official Telephone Number:
413-504-4492

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  DS3178 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0496901 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2239588 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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