1821238148 NPI number — BENTLEY SAINT FRANCIS, LLC

Table of content: MR. DANIEL GEORGE BAUMSTARK MSPT (NPI 1487680450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821238148 NPI number — BENTLEY SAINT FRANCIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENTLEY SAINT FRANCIS, LLC
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:
1821238148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 THORNE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-755-8605
Provider Business Mailing Address Fax Number:
508-791-6954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 THORNE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-752-2546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RASO
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED AGENT
Authorized Official Telephone Number:
978-372-4004

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110081997B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1907107 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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