1700815941 NPI number — TOWN OF STERLING

Table of content: MR. WILLIAM DALE VIS LMSW (NPI 1801301064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700815941 NPI number — TOWN OF STERLING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF STERLING
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:
1700815941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2K
Provider Business Mailing Address City Name:
SUTTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01590-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-476-9740
Provider Business Mailing Address Fax Number:
508-476-9748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01564-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-422-3040
Provider Business Practice Location Address Fax Number:
978-422-7832
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HURLBUT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
978-422-3040

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3310 , 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: 102659 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1721151 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0033027 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 820906 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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