1942313440 NPI number — TOWN OF ENFIELD BOARD OF EDUCATION

Table of content: (NPI 1942313440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942313440 NPI number — TOWN OF ENFIELD BOARD OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF ENFIELD BOARD OF EDUCATION
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:
TOWN OF ENFIELD EMS
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:
1942313440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 TURCOTTE MEMORIAL DR
Provider Second Line Business Mailing Address:
C/O COMSTAR
Provider Business Mailing Address City Name:
ROWLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01969-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-488-4351
Provider Business Mailing Address Fax Number:
978-356-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1296 ENFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-253-5243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIEMOKLY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
860-253-2543

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  C049P1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: C049P1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 710C049B1CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P00238538 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 710C049B1CT01 . This is a "BLUE CARE FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004243622 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611447600 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 661997 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




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