1093714412 NPI number — FIRST PSYCHIATRIC PLANNERS, INC

Table of content: (NPI 1093714412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093714412 NPI number — FIRST PSYCHIATRIC PLANNERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST PSYCHIATRIC PLANNERS, INC
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:
6
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:
1093714412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-3658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-469-0300
Provider Business Mailing Address Fax Number:
617-469-5013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-469-0300
Provider Business Practice Location Address Fax Number:
617-469-5013
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GALE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
617-469-0300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  636 , 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: 001380 . This is a "VALUEOPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1209027 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 996093 . This is a "NETWORK HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 104969 . This is a "MAGELLAN BEHAVIORAL HLTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000465 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BOU2222400901 . This is a "BLUE CROSS INPATIENT #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 906672 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BOU2222400910 . This is a "BLUE CROSS OUTPATIENT #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1102303 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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