1669536819 NPI number — TOWN OF MILLIS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669536819 NPI number — TOWN OF MILLIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF MILLIS
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:
1669536819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 MAIN ST
Provider Second Line Business Mailing Address:
ROOM 213
Provider Business Mailing Address City Name:
MILLIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02054-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-376-7042
Provider Business Mailing Address Fax Number:
508-376-7058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 MAIN ST
Provider Second Line Business Practice Location Address:
ROOM 213
Provider Business Practice Location Address City Name:
MILLIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02054-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-376-7042
Provider Business Practice Location Address Fax Number:
508-376-7058
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSO
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ACTING TREASURER
Authorized Official Telephone Number:
508-376-7091

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  153518 , 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)





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