1871570598 NPI number — COOKE & BURNELL ORTHOPEDICS & CONVALESCENT SUPPLIES, INC

Table of content: (NPI 1871570598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871570598 NPI number — COOKE & BURNELL ORTHOPEDICS & CONVALESCENT SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOKE & BURNELL ORTHOPEDICS & CONVALESCENT SUPPLIES, 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:
1871570598
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:
741 TYLER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-443-4431
Provider Business Mailing Address Fax Number:
413-499-8877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 TYLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-443-4431
Provider Business Practice Location Address Fax Number:
413-499-8877
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COOKE
Authorized Official First Name:
EVERETTE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-443-4431

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 11533 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 702246 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 23188 . This is a "HEALTH NET BOSTON MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 803143 . This is a "TUFTS HEALTHPLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 117354 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 650630 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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