1255365029 NPI number — TOWN OF COLCHESTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255365029 NPI number — TOWN OF COLCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF COLCHESTER
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:
1255365029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 BLAKELY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-654-0770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOEHM
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TOWN ADMINISTARTOR
Authorized Official Telephone Number:
802-654-0770

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0303 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0AM0064 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0369000434 . This is a "TRIAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00038242 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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