1962536607 NPI number — PHYSICIANS OF NORTH WORCESTER COUNTY

Table of content: (NPI 1962536607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962536607 NPI number — PHYSICIANS OF NORTH WORCESTER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS OF NORTH WORCESTER COUNTY
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:
1962536607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 HIGHLAND ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01510-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-368-3870
Provider Business Mailing Address Fax Number:
978-368-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 MECHANIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHOL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01331-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-249-7818
Provider Business Practice Location Address Fax Number:
978-249-4445
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLAMINIANO
Authorized Official First Name:
LOURDES
Authorized Official Middle Name:
BANTING
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-368-3870

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M15501 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9768874 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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