Provider Demographics
NPI:1396736377
Name:TOWN OF EDGARTOWN
Entity type:Organization
Organization Name:TOWN OF EDGARTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHEMETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-627-5167
Mailing Address - Street 1:9 MAIN ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-1660
Mailing Address - Country:US
Mailing Address - Phone:508-476-9740
Mailing Address - Fax:508-476-9748
Practice Address - Street 1:68 PEASE POINT WAY
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539
Practice Address - Country:US
Practice Address - Phone:508-627-5167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011192Medicaid
MA031859OtherBCBS
700087OtherHARVARD PILGRIM
MA1720708Medicaid
0023906OtherNEIGHBORHOOD HEALTH
0593297OtherBLUE CROSS BLUE SHIELD
MA4523OtherHEALTH NET FEDERAL
590013475OtherRR MEDICARE
NH30011192Medicaid
MA4523OtherHEALTH NET FEDERAL