1205821204 NPI number — TOWN OF BRISTOL

Table of content: (NPI 1205821204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205821204 NPI number — TOWN OF BRISTOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BRISTOL
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:
1205821204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
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:
978-356-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03222-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-744-3354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YANNUZZI
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
603-744-2632

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0014 , 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: 7106270Y0NH01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 49006270 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590009688 . This is a "RR MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 688316 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 606172 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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