1093708927 NPI number — CENTRAL MASS ALLERGY & ASTHMA CARE

Table of content: (NPI 1093708927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093708927 NPI number — CENTRAL MASS ALLERGY & ASTHMA CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MASS ALLERGY & ASTHMA CARE
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:
1093708927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MLK JR BLVD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-757-1589
Provider Business Mailing Address Fax Number:
508-756-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MLK JR BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-757-1589
Provider Business Practice Location Address Fax Number:
508-756-5633
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
508-757-1589

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 57871 . This is a "FALLON HEALTH PLAN GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0028926 . This is a "NEIGHBORHOOD HEALTH GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 691549 . This is a "TUFTS HEALTH PLAN GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9751688 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17542 . This is a "BLUE SHIELD GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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