Provider Demographics
NPI:1326018201
Name:TOWN OF SOUTHBOROUGH
Entity Type:Organization
Organization Name:TOWN OF SOUTHBOROUGH
Other - Org Name:SOUTHBOROUGH FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURO, JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-485-3235
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:
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1639
Practice Address - Country:US
Practice Address - Phone:508-485-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3032341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022607OtherNEIGHBORHOOD HEALTH
MA037859OtherBLUE CROSS BLUE SHIELD
NY151066XXOtherPREFERRED CARE
MA1708716Medicaid
700488OtherHARVARD PILGRIM
800634OtherTUFTS HEALTH PLAN
MA1708716Medicaid