1750492468 NPI number — MR. KEITH LINSEY MS PT

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 1750492468 NPI number — MR. KEITH LINSEY MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINSEY
Provider First Name:
KEITH
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
M

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:
1750492468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 PEARL STREET
Provider Second Line Business Mailing Address:
NORTH SUBURBAN ORTHOPEDIC ASSOCIATES INC
Provider Business Mailing Address City Name:
MADLEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-321-8785
Provider Business Mailing Address Fax Number:
781-321-8063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 MAIN STREET
Provider Second Line Business Practice Location Address:
NSOA PT UNIT
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-979-2519
Provider Business Practice Location Address Fax Number:
781-979-2520
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10624 , 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: Y67322 . This is a "BCBS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000Y61011 . This is a "BCBS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 612930 . This is a "TUFTS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6135212 . This is a "HARVARD PILGRIM GROUP" identifier . This identifiers is of the category "OTHER".




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