1033584743 NPI number — J FROST SERVICES

Table of content: (NPI 1033584743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033584743 NPI number — J FROST SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J FROST SERVICES
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:
1033584743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-594-1122
Provider Business Mailing Address Fax Number:
413-594-1100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SPRINGFIELD ST
Provider Second Line Business Practice Location Address:
ANNEX A, SUITE 6
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01013-2672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-594-1122
Provider Business Practice Location Address Fax Number:
413-594-1100
Provider Enumeration Date:
12/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FROST
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
413-594-1122

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  114330 , 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: 110082939B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com