1174681712 NPI number — CITY OF LEBANON

Table of content: (NPI 1174681712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174681712 NPI number — CITY OF LEBANON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LEBANON
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:
1174681712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 TURCOTTE MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01969-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-488-4351
Provider Business Mailing Address Fax Number:
603-448-8811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 S. PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-448-8810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOPOULOS
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
603-448-8810

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0203 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 0203 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 49055 . This is a "VT BCBS PROVIDER #" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 30820557 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590013846 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: NH00235 . This is a "NH BCBS PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0AM0075 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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