Provider Demographics
NPI:1285850651
Name:TOWN OF MERRIMAC
Entity Type:Organization
Organization Name:TOWN OF MERRIMAC
Other - Org Name:BOARD OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:STEPANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN-BC
Authorized Official - Phone:978-346-8035
Mailing Address - Street 1:2 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1915
Mailing Address - Country:US
Mailing Address - Phone:978-346-4066
Mailing Address - Fax:978-346-0527
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1612
Practice Address - Country:US
Practice Address - Phone:978-346-9549
Practice Address - Fax:978-346-8289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF MERRIMAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12358251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11030Medicare PIN
MAY11030Medicare ID - Type UnspecifiedFLU AND PNEUMONIA ROSTER