Provider Demographics
NPI:1124004486
Name:NORTH BROOKFIELD EMERGENCY SQUAD
Entity Type:Organization
Organization Name:NORTH BROOKFIELD EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRITSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-867-6308
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:56 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-1927
Practice Address - Country:US
Practice Address - Phone:508-867-6308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3295341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000028196OtherBMC HEALTHNET PLAN
MA1700669Medicaid
590010496OtherRR MEDICARE
337448OtherTUFTS HEALTH
0019310OtherNEIGHBORHOOD HEALTH
MA070059OtherBLUE CROSS BLUE SHIELD
604270OtherHARVARD PILGRIM
0019310OtherNEIGHBORHOOD HEALTH