Provider Demographics
NPI:1326018011
Name:JIM PREVETT
Entity Type:Organization
Organization Name:JIM PREVETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PREVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-925-9493
Mailing Address - Street 1:129 MANOMET AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2128
Mailing Address - Country:US
Mailing Address - Phone:781-925-9493
Mailing Address - Fax:781-925-1203
Practice Address - Street 1:129 MANOMET AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2128
Practice Address - Country:US
Practice Address - Phone:781-925-9493
Practice Address - Fax:781-925-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4819330001Medicare NSC