Provider Demographics
NPI:1790834141
Name:TOWN OF RANDOLPH
Entity Type:Organization
Organization Name:TOWN OF RANDOLPH
Other - Org Name:RANDOLPH FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF DEPARTMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-961-0992
Mailing Address - Street 1:19 NORFOLK AVE STE B
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:888-771-6115
Mailing Address - Fax:508-297-2699
Practice Address - Street 1:10 MEMORIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4537
Practice Address - Country:US
Practice Address - Phone:781-961-0992
Practice Address - Fax:781-961-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1701274Medicaid
012959Medicare ID - Type Unspecified