1447469937 NPI number — AMERICAN WELLNESS CENTER

Table of content: (NPI 1447469937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447469937 NPI number — AMERICAN WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN WELLNESS CENTER
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:
1447469937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 W MAIN ST
Provider Second Line Business Mailing Address:
STE #1
Provider Business Mailing Address City Name:
DUDLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-943-9561
Provider Business Mailing Address Fax Number:
508-943-4143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 W MAIN ST
Provider Second Line Business Practice Location Address:
STE #1
Provider Business Practice Location Address City Name:
DUDLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-943-9561
Provider Business Practice Location Address Fax Number:
508-943-4143
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BILODEAU
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
508-943-9561

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  402 , 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: Y35291 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2752321 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1602152 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y3721 . This is a "HARVARD PILGRIM AA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1020501 . This is a "FALLEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 847659200 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97834301 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".




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