Provider Demographics
NPI:1851388136
Name:TOWN OF CHARLTON
Entity Type:Organization
Organization Name:TOWN OF CHARLTON
Other - Org Name:CHARLTON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-248-2276
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 1:10 POWER STATION RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1920
Practice Address - Country:US
Practice Address - Phone:508-248-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3272341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1705652Medicaid
MA006659OtherBLUE CROSS BLUE SHEILD
MA7040OtherFALLON COMMUNITY
MA0019165OtherNEIGHBORHOOD HEALTH
MA006659OtherMASS MEDEX
803954OtherTUFTS HEALTH PLAN
606530500OtherDEPARTMENT OF LABOR
590088111OtherRR MEDICARE
700339OtherHARVARD PILGRIM
MA006659OtherBLUE CROSS BLUE SHEILD
=========OtherTRICARE