Provider Demographics
NPI:1417917998
Name:TOWN OF PEPPERELL
Entity Type:Organization
Organization Name:TOWN OF PEPPERELL
Other - Org Name:PEPPERELL FIRE DEPARTMENT / EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING CLERK / OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-433-0303
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463
Mailing Address - Country:US
Mailing Address - Phone:978-433-0303
Mailing Address - Fax:978-433-0306
Practice Address - Street 1:ONE MAIN STREET
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463
Practice Address - Country:US
Practice Address - Phone:978-433-0303
Practice Address - Fax:978-433-0306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF PEPPERELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22D1040298291U00000X
MA34963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1705430Medicaid
MA019959Medicare ID - Type UnspecifiedPROVIDER NUMBER
019959Medicare PIN