Provider Demographics
NPI:1356324289
Name:TOWN OF KINGSTON
Entity Type:Organization
Organization Name:TOWN OF KINGSTON
Other - Org Name:KINGSTON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-585-0531
Mailing Address - Street 1:PO BOX 4110
Mailing Address - Street 2:DEPT 5280
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-4110
Mailing Address - Country:US
Mailing Address - Phone:781-585-0531
Mailing Address - Fax:
Practice Address - Street 1:105 PEMBROKE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1103
Practice Address - Country:US
Practice Address - Phone:781-585-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3130341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
700623OtherHARVARD PILGRIM
MA1713868Medicaid
590006201OtherRR MEDICARE
801897OtherTUFTS HEALTH PLAN
000000026329OtherBMC HEALTHNET PLAN
0018977OtherNEIGHBORHOOD HEALTH
0018977OtherNEIGHBORHOOD HEALTH