Provider Demographics
NPI:1104973510
Name:TOWN OF GRANBY
Entity type:Organization
Organization Name:TOWN OF GRANBY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-467-9697
Mailing Address - Street 1:250 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9417
Mailing Address - Country:US
Mailing Address - Phone:413-467-9697
Mailing Address - Fax:
Practice Address - Street 1:8 TURCOTTE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-1706
Practice Address - Country:US
Practice Address - Phone:800-488-4351
Practice Address - Fax:978-356-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3332341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000031659OtherBCBS OF MASS
MA031659Medicare UPIN