1982604849 NPI number — TOWN OF BRANFORD

Table of content: (NPI 1982604849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982604849 NPI number — TOWN OF BRANFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BRANFORD
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:
6
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:
1982604849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-488-7266
Provider Business Mailing Address Fax Number:
203-315-3349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06405-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-488-7266
Provider Business Practice Location Address Fax Number:
203-315-3349
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAHONEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
203-488-7266

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004048021 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00404802100 . This is a "BLUE CARE FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 710C014A2CT01 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004048021 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 441590934 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OR0860 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com