Provider Demographics
NPI:1639142672
Name:TOWN OF TISBURY
Entity Type:Organization
Organization Name:TOWN OF TISBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-696-4250
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:
Practice Address - Street 1:51 SPRING ST
Practice Address - Street 2:
Practice Address - City:TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02568-5501
Practice Address - Country:US
Practice Address - Phone:508-696-4250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3153341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA095059OtherBLUE CROSS BLUE SHIELD
MA1720015Medicaid
802758OtherTUFTS HEALTH PLAN
706250OtherHARVARD PILGRIM
590014097OtherRR MEDICARE
MA095059OtherBLUE CROSS BLUE SHIELD