1992800957 NPI number — TOWN CENTER PEDIATRICS

Table of content: (NPI 1992800957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992800957 NPI number — TOWN CENTER PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN CENTER PEDIATRICS
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:
1992800957
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:
PO BOX 296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01772-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-229-8811
Provider Business Mailing Address Fax Number:
508-229-0666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 CORDAVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 185
Provider Business Practice Location Address City Name:
SOUTHBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01772-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-229-8811
Provider Business Practice Location Address Fax Number:
508-229-0666
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPAULDING
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
508-229-8811

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44778 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 615411 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: M16823 . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9783164 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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