1205823085 NPI number — COLRAIN VOL AMB ASSOC, INC

Table of content: (NPI 1205823085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205823085 NPI number — COLRAIN VOL AMB ASSOC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLRAIN VOL AMB ASSOC, INC
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:
1205823085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2013
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:
51 MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLRAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01340-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-624-5528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PONCE
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/DIRECTOR
Authorized Official Telephone Number:
413-624-0128

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3369 , 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: 807136 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000027770 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 076259 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 590012303 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042349458 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1715585 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH1050 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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