1023160454 NPI number — MELROSE WAKEFIELD CARDIAC TESTING PARTNERSHIP

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 1023160454 NPI number — MELROSE WAKEFIELD CARDIAC TESTING PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELROSE WAKEFIELD CARDIAC TESTING PARTNERSHIP
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:
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:
1023160454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 BROADWAY
Provider Second Line Business Mailing Address:
ATTN: MELROSE CARDRIAC TESTING PARTNERSHIP
Provider Business Mailing Address City Name:
SAUGUS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01906-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-979-6351
Provider Business Mailing Address Fax Number:
781-979-6373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 LEBANON STREET (MELROSE WAKEFIELD HOSPITAL)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02176-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-979-6351
Provider Business Practice Location Address Fax Number:
781-979-6373
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WATROUS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT MELROSE WAKEFIELD TESTIN
Authorized Official Telephone Number:
781-942-0606

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M14655 . This is a "MA BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9758372 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com