Provider Demographics
NPI:1902889405
Name:TOWN OF LONGMEADOW
Entity type:Organization
Organization Name:TOWN OF LONGMEADOW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DEARBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-567-3357
Mailing Address - Street 1:44 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1950
Mailing Address - Country:US
Mailing Address - Phone:413-567-3357
Mailing Address - Fax:
Practice Address - Street 1:44 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1950
Practice Address - Country:US
Practice Address - Phone:413-567-3357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3979341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
804040OtherTUFTS HEALTH PLAN
0022864OtherNEIGHBORHOOD HEALTH
000000027128OtherBMC HEALTHNET
MA1715364Medicaid
441590830OtherRR MEDICARE
645904OtherHARVARD PILGRIM
0022864OtherNEIGHBORHOOD HEALTH