Provider Demographics
NPI:1124091673
Name:TOWN OF TEWKSBURY
Entity type:Organization
Organization Name:TOWN OF TEWKSBURY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-640-4410
Mailing Address - Street 1:19 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1911
Mailing Address - Country:US
Mailing Address - Phone:508-297-2068
Mailing Address - Fax:508-297-2699
Practice Address - Street 1:21 TOWN HALL AVE
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2752
Practice Address - Country:US
Practice Address - Phone:978-640-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3062341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA041259OtherBLUE CROSS BLUE SHIELD
MA1709917Medicaid
802751OtherTUFTS HEALTH PLAN
000000022440OtherBMC HEALTHNET PLAN
0008642OtherNEIGHBORHOOD HEALTH PLAN
590001093OtherRR MEDICARE
700765OtherHARVARD PILGRIM
700765OtherHARVARD PILGRIM
802751OtherTUFTS HEALTH PLAN