1255348975 NPI number — CITY OF LEOMINSTER

Table of content: (NPI 1255348975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255348975 NPI number — CITY OF LEOMINSTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LEOMINSTER
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:
1255348975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 NORFOLK AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH EASTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02375-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-771-6115
Provider Business Mailing Address Fax Number:
978-356-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-534-7545
Provider Business Practice Location Address Fax Number:
978-537-6567
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAPLANTE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
R
Authorized Official Title or Position:
TREASURER, CITY OF LEOMINSTER
Authorized Official Telephone Number:
978-534-7509

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3288 , 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: 1700294 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011459 . This is a "BLUE CROSS PROVIDER NUMBR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012583 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 590006997 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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