1952312969 NPI number — SARA G SHIELDS FAMILY PRACTICE

Table of content: SARA G SHIELDS FAMILY PRACTICE (NPI 1952312969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952312969 NPI number — SARA G SHIELDS FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
SARA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FAMILY PRACTICE
Provider Gender Code:
F

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:
1952312969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 QUEEN ST
Provider Second Line Business Mailing Address:
MEDICAL
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01610-2473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-860-7700
Provider Business Mailing Address Fax Number:
508-860-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 QUEEN ST
Provider Second Line Business Practice Location Address:
MEDICAL
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01610-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-860-7700
Provider Business Practice Location Address Fax Number:
508-860-7990
Provider Enumeration Date:
08/11/2006

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: 207Q00000X , with the licence number:  78916 , 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: 7032 . This is a "FALLON SELECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006767 . This is a "NHP-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0080097 . This is a "EVERCARE-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0105221 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7897 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J16368 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1300709 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99734701 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2094515 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 23462 . This is a "CMSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 347290 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y10141 . This is a "BCBS-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0002449 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1300709 . This is a "CMSP-GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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