1871033019 NPI number — MR. KEITH D TURCOTTE NP

Table of content: MR. KEITH D TURCOTTE NP (NPI 1871033019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871033019 NPI number — MR. KEITH D TURCOTTE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURCOTTE
Provider First Name:
KEITH
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

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:
1871033019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 SOUTHWOODS BLVD
Provider Second Line Business Mailing Address:
CAPITAL CARDIOLOGY ASSOCIATES, PC
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12211-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-292-6000
Provider Business Mailing Address Fax Number:
518-292-6050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02721-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-676-3292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2017

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: 363L00000X , with the licence number:  F341435 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN2334699 , 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: 04762263 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1030489 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110122580A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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