1194879007 NPI number — TOWN OF BOYLSTON

Table of content: (NPI 1194879007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194879007 NPI number — TOWN OF BOYLSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BOYLSTON
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:
1194879007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 634
Provider Second Line Business Mailing Address:
599 MAIN STREET
Provider Business Mailing Address City Name:
BOYLSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01505-0634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-869-2342
Provider Business Mailing Address Fax Number:
508-869-6101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYLSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01505-0634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-869-2342
Provider Business Practice Location Address Fax Number:
508-869-6101
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
508-869-2342

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , 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: 1715461 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 035459 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1715461 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 035459 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 804092 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701220 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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