1831388552 NPI number — BENJAMIN C DICKERT

Table of content: (NPI 1831388552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831388552 NPI number — BENJAMIN C DICKERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENJAMIN C DICKERT
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:
BENJAMIN C.DICKERT
Provider Other Organization Name Type Code:
3
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:
1831388552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 CAREW ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01104-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-736-3225
Provider Business Mailing Address Fax Number:
413-736-3382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 CAREW ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-736-3225
Provider Business Practice Location Address Fax Number:
413-736-3382
Provider Enumeration Date:
10/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DICKERT
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
413-736-3225

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: PD1884 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Y77346 . This is a "BLUE CROSS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002099 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0362662 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y70887 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000028039 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 333305 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y71046 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000006878 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7390036 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0310832 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33901 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6332349 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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