1528057320 NPI number — TOWN OF DOVER

Table of content: (NPI 1528057320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528057320 NPI number — TOWN OF DOVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF DOVER
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:
1528057320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
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:
5 SPRINGDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02030-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-785-1130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TIBERI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
508-785-1130

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3605 , 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: 046001072 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800783 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1716085 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700178 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 033059 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 590011206 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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