Provider Demographics
NPI:1164576054
Name:TOWN OF BOLTON
Entity Type:Organization
Organization Name:TOWN OF BOLTON
Other - Org Name:BOLTON VOLUNTEER AMBULANCE SQUAD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-779-7801
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 1:15 WATTAQUADOCK HILL ROAD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740
Practice Address - Country:US
Practice Address - Phone:978-779-7800
Practice Address - Fax:978-779-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1721135Medicaid
MAZM0918OtherBCBS PROVIDER NUMBER
MAAM0174Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER