Provider Demographics
NPI:1346376704
Name:TOWN OF SUNDERLAND
Entity Type:Organization
Organization Name:TOWN OF SUNDERLAND
Other - Org Name:SUNDERLAND AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF / AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-665-2465
Mailing Address - Street 1:9 MAIN ST STE 2K
Mailing Address - Street 2:
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 1:105 RIVER RD
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-6901
Practice Address - Country:US
Practice Address - Phone:413-665-2465
Practice Address - Fax:413-665-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3416L0300X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1715291Medicaid
MA098259Medicare ID - Type Unspecified