1346233715 NPI number — TOWN OF BOXBOROUGH

Table of content: (NPI 1346233715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346233715 NPI number — TOWN OF BOXBOROUGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BOXBOROUGH
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:
1346233715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4110
Provider Second Line Business Mailing Address:
DEPT 790
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01888-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-264-1770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 MIDDLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOXBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01719-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-263-7546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
978-264-1770

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3663 , 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: 036459 . This is a "BC/BS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 590013465 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 800458 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1715542 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 701201 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020222 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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