Provider Demographics
NPI:1356330393
Name:TOWN OF EAST BROOKFIELD
Entity Type:Organization
Organization Name:TOWN OF EAST BROOKFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-867-3124
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:800-488-4351
Mailing Address - Fax:
Practice Address - Street 1:273 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01515-1617
Practice Address - Country:US
Practice Address - Phone:508-867-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3275341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
0625800OtherANTHEM BLUE CROSS
MA1713213Medicaid
7074OtherFALLON COMMUNITY
0460001138OtherTRICARE
0017791OtherNEIGHBORHOOD HEALTH
CT701954OtherHARVARD PILGRIM
803118OtherTUFTS HEALTH PLAN
MA077259OtherBLUE CROSS BLUE SHIELD
NH30820319Medicaid
NHAM0062Medicare ID - Type Unspecified
MA077259Medicare ID - Type Unspecified