1366878910 NPI number — RX2EDUCATE CLINICAL INSTITUTE INC

Table of content: (NPI 1366878910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366878910 NPI number — RX2EDUCATE CLINICAL INSTITUTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX2EDUCATE CLINICAL INSTITUTE 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:
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:
1366878910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 104- 244
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02021-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-924-5228
Provider Business Mailing Address Fax Number:
781-609-7973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02190-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-924-5228
Provider Business Practice Location Address Fax Number:
781-609-7973
Provider Enumeration Date:
09/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-924-5228

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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