1043396195 NPI number — DR. MARY S TRUEX D.C.

Table of content: DR. MARY S TRUEX D.C. (NPI 1043396195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043396195 NPI number — DR. MARY S TRUEX D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUEX
Provider First Name:
MARY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1043396195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 GUNNERS EXCHANGE ROAD
Provider Second Line Business Mailing Address:
PO BOX 1225
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02362-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-746-8701
Provider Business Mailing Address Fax Number:
508-746-8873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 ALDRIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-3995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-747-2900
Provider Business Practice Location Address Fax Number:
508-747-2980
Provider Enumeration Date:
10/31/2006

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: 111N00000X , with the licence number:  CH259 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 259 , 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: 1602977 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000259 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y35085 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35900 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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