1710020656 NPI number — ALTHAUSEN MCGOVERN ASSOC INC

Table of content: (NPI 1710020656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710020656 NPI number — ALTHAUSEN MCGOVERN ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTHAUSEN MCGOVERN ASSOC 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:
1710020656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HAWTHORNE PL
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-557-5422
Provider Business Mailing Address Fax Number:
617-523-8974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HAWTHORNE PL
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-557-5422
Provider Business Practice Location Address Fax Number:
617-523-8974
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOVERN
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-523-2394

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  55277 , 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)

  • Identifier: 340015721 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16636 . This is a "MEDEX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9738037 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004946 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16636 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 616567 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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