Provider Demographics
NPI:1740219518
Name:TOWN OF HOLLISTON
Entity Type:Organization
Organization Name:TOWN OF HOLLISTON
Other - Org Name:HOLLISTON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:FC
Authorized Official - Phone:508-429-4631
Mailing Address - Street 1:1 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2303
Mailing Address - Country:US
Mailing Address - Phone:781-828-3533
Mailing Address - Fax:781-828-2471
Practice Address - Street 1:59 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2103
Practice Address - Country:US
Practice Address - Phone:508-429-4631
Practice Address - Fax:508-429-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1714643Medicaid
MA608366OtherTUFTS HEALTH PLAN
MA702063OtherHARVARD PILGRIM HEALTH
MA094559OtherBLUE CROSS & BLUE SHIELD
MA094559OtherBLUE CROSS & BLUE SHIELD