Provider Demographics
NPI:1619979796
Name:TOWN OF ANDOVER
Entity Type:Organization
Organization Name:TOWN OF ANDOVER
Other - Org Name:ANDOVER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRENDAN
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-475-1281
Mailing Address - Street 1:19 NORFOLK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1911
Mailing Address - Country:US
Mailing Address - Phone:508-297-2068
Mailing Address - Fax:508-297-2699
Practice Address - Street 1:32 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3513
Practice Address - Country:US
Practice Address - Phone:978-475-1281
Practice Address - Fax:978-475-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1700871Medicaid
MA000000028099OtherBMC HEALTHNET PLAN
MA016059OtherMASS MEDEX
MA103474100OtherDEPARTMENT OF LABOR
MA0008794OtherNEIGHBORHOOD HEALTH
MA10694OtherFALLON
MA016059OtherBC/BS
MA590011162OtherRR MEDICARE
MA700591OtherHARVARD PILGRIM
MA801595OtherTUFTS
NY155028XXOtherPREFERRED CARE NY
MA590011162OtherRR MEDICARE