1487789608 NPI number — TOWN OF MERRIMAC

Table of content: ELEANOR H YOON MD (NPI 1053302596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487789608 NPI number — TOWN OF MERRIMAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF MERRIMAC
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:
1487789608
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:
508-297-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIMAC
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01860-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-346-8211
Provider Business Practice Location Address Fax Number:
978-346-9227
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
978-346-8211

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3849 , 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: T0039159 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1708996 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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