1720131642 NPI number — TOWN OF WESTPORT

Table of content: (NPI 1720131642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720131642 NPI number — TOWN OF WESTPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WESTPORT
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:
1720131642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02790-0703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-672-0721
Provider Business Mailing Address Fax Number:
508-672-0287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 BRIGGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02790-4020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-672-0721
Provider Business Practice Location Address Fax Number:
508-672-0287
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEGENDRE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
508-636-1110

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3178 , 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: 1709453 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 802185 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: S014372 . This is a "CHAMPUSTRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000024886 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0021568 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 23853-1 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 037959 . This is a "BLUE CROSS BLUE SHIELD MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81-00042 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700107 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".




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