Provider Demographics
NPI:1366658189
Name:CITY OF SOMERVILLE
Entity Type:Organization
Organization Name:CITY OF SOMERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-625-6600
Mailing Address - Street 1:50 EVERGREEN AVE
Mailing Address - Street 2:CITY HALL ANNEX, HEALTH DEPT.
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2819
Mailing Address - Country:US
Mailing Address - Phone:617-625-6600
Mailing Address - Fax:617-629-3040
Practice Address - Street 1:50 EVERGREEN AVE
Practice Address - Street 2:CITY HALL ANNEX, HEALTH DEPT.
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2819
Practice Address - Country:US
Practice Address - Phone:617-625-6600
Practice Address - Fax:617-629-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203832251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACIY11092Medicare PIN