Provider Demographics
NPI:1952476905
Name:TOWN OF LUDLOW
Entity Type:Organization
Organization Name:TOWN OF LUDLOW
Other - Org Name:LUDLOW BOARD OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN BOARD OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-583-5600
Mailing Address - Street 1:488 CHAPIN ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2523
Mailing Address - Country:US
Mailing Address - Phone:413-583-5600
Mailing Address - Fax:413-583-5689
Practice Address - Street 1:488 CHAPIN ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2523
Practice Address - Country:US
Practice Address - Phone:413-583-5600
Practice Address - Fax:413-583-5689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF LUDLOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11047Medicare ID - Type Unspecified