1972900553 NPI number — ULTRACARE, P.C.

Table of content: (NPI 1972900553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972900553 NPI number — ULTRACARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULTRACARE, P.C.
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:
1972900553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02303-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-510-5221
Provider Business Mailing Address Fax Number:
508-510-5126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-510-4221
Provider Business Practice Location Address Fax Number:
508-510-5126
Provider Enumeration Date:
11/26/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIVEIROS
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
508-675-2840

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , 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: 1013960152 . This is a "MARCI SERONICK, D.C. INDIVIDUAL NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1184673956 . This is a "JOHN A. MARSHALL, D.C. INDIVIDUAL NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1629214002 . This is a "ALLISON HURLEY, D.C. INDIVIDUAL NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".