Provider Demographics
NPI:1528034493
Name:TOWN OF WATERTOWN
Entity Type:Organization
Organization Name:TOWN OF WATERTOWN
Other - Org Name:WATERTOWN FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-972-6511
Mailing Address - Street 1:149 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4410
Mailing Address - Country:US
Mailing Address - Phone:617-682-1854
Mailing Address - Fax:
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4410
Practice Address - Country:US
Practice Address - Phone:617-972-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3437341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000023044OtherBMC HEALTHNET PLAN
590005406OtherRR MEDICARE
700879OtherHARVARD PILGRIM
0007373OtherNEIGHBORHOOD HEALTH
MA1707981Medicaid
MA035559OtherBLUE CROSS BLUE SHIELD
801818OtherTUFTS HEALTH PLAN
249573200OtherDEPARTMENT OF LABOR
590005406OtherRR MEDICARE