1174761480 NPI number — DR. ANTOINETTE D. PARVIS, PC

Table of content: (NPI 1174761480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174761480 NPI number — DR. ANTOINETTE D. PARVIS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ANTOINETTE D. PARVIS, PC
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:
1174761480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01540-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-987-3237
Provider Business Mailing Address Fax Number:
508-987-0494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01540-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-987-3237
Provider Business Practice Location Address Fax Number:
508-987-0494
Provider Enumeration Date:
01/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARVIS
Authorized Official First Name:
ANTOINETTE
Authorized Official Middle Name:
DOMENICA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-987-3237

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3698-TP , 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: 0369926 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 467304 . This is a "EYE-MED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 980429 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 43499 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16082 . This is a "BLUE-CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 115185 . This is a "FALLON SELECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 22000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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