1164574661 NPI number — TOWN OF WHATELY

Table of content: (NPI 1164574661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164574661 NPI number — TOWN OF WHATELY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WHATELY
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:
1164574661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2K
Provider Business Mailing Address City Name:
SUTTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01590-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-476-9740
Provider Business Mailing Address Fax Number:
508-476-9748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 CHRISTIAN LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHATELY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-665-4400
Provider Business Practice Location Address Fax Number:
413-665-2230
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CHAIR, BOARD OF SELECTMEN
Authorized Official Telephone Number:
413-665-4400

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3382 , 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: 1715003 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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