Provider Demographics
NPI:1366482606
Name:TOWN OF AGAWAM
Entity Type:Organization
Organization Name:TOWN OF AGAWAM
Other - Org Name:AGAWAM FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-726-2880
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:978-356-2721
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:AGAWAM AMBULANCE SERVICE
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2576
Practice Address - Country:US
Practice Address - Phone:413-786-2662
Practice Address - Fax:413-786-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MA36593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1713736Medicaid
MA803955OtherTUFTS HEALTH PLANS
MA099459OtherBLUE CROSS & BLUE SHIELD
MA701169OtherHARVARD PILGRIM HEALTH
MA099459OtherBLUE CROSS & BLUE SHIELD