Provider Demographics
NPI:1164574661
Name:TOWN OF WHATELY
Entity Type:Organization
Organization Name:TOWN OF WHATELY
Other - Org Name:WHATELY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIR, BOARD OF SELECTMEN
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-665-4400
Mailing Address - Street 1:9 MAIN ST
Mailing Address - Street 2:SUITE 2K
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 1:63 CHRISTIAN LANE
Practice Address - Street 2:
Practice Address - City:WHATELY
Practice Address - State:MA
Practice Address - Zip Code:01093
Practice Address - Country:US
Practice Address - Phone:413-665-4400
Practice Address - Fax:413-665-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1715003Medicaid
MA097359Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER