1588725543 NPI number — YANKEE MEDICAL INC

Table of content: (NPI 1295399079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588725543 NPI number — YANKEE MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YANKEE MEDICAL 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:
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:
1588725543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05401-2918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-863-4591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 MECHANIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-448-8853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FICOCIELLO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-863-4591

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00358269 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99007330 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007330 . This is a "BCBS VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1505 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1200915YONH01 . This is a "NH BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0007330 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com