1851352850 NPI number — MS. SUSAN M GRUEN F.N.P.

Table of content: MS. SUSAN M GRUEN F.N.P. (NPI 1851352850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851352850 NPI number — MS. SUSAN M GRUEN F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUEN
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REILLY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
F,N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851352850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01102-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-431-4077
Provider Business Mailing Address Fax Number:
413-774-7448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MAIN ST
Provider Second Line Business Practice Location Address:
NORTHAMPTON HEALTH CENTER
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01062-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-586-8400
Provider Business Practice Location Address Fax Number:
413-585-5435
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  131025 , 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: 1293396 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 131025 . This is a "CONNECTICARE, INC." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 500016108 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NP2352 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0351491 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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