Provider Demographics
NPI:1942451109
Name:TOWN OF FITZWILLIAM
Entity Type:Organization
Organization Name:TOWN OF FITZWILLIAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-452-8191
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:800-452-8191
Mailing Address - Fax:860-563-3403
Practice Address - Street 1:13 TEMPLETON TURNPIKE
Practice Address - Street 2:
Practice Address - City:FITZWILLIAMS
Practice Address - State:NH
Practice Address - Zip Code:03447-0725
Practice Address - Country:US
Practice Address - Phone:603-585-7723
Practice Address - Fax:603-585-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0259341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30827085Medicaid
NHP00672352OtherRAILROAD MEDICARE
NHP00672352OtherRAILROAD MEDICARE