1912931841 NPI number — DR. TERRANCE GARTH AUSSANT DC

Table of content: DR. TERRANCE GARTH AUSSANT DC (NPI 1912931841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912931841 NPI number — DR. TERRANCE GARTH AUSSANT DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSSANT
Provider First Name:
TERRANCE
Provider Middle Name:
GARTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1912931841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-431-2920
Provider Business Mailing Address Fax Number:
508-431-2925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-431-2520
Provider Business Practice Location Address Fax Number:
508-431-2925
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DCP 00521 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 2877 , 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: 1050734 . This is a "AMERICAN SPECIALTY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 291965 . This is a "BCBS OF RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3564893 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 664484 . This is a "ACN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043379412 . This is a "LANDMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA20597 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7256986 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043379412 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y39819 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".




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