Provider Demographics
NPI:1134256423
Name:TOWN OF ATHOL
Entity type:Organization
Organization Name:TOWN OF ATHOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-249-7934
Mailing Address - Street 1:584 MAIN ST
Mailing Address - Street 2:ROOM 1
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-1824
Mailing Address - Country:US
Mailing Address - Phone:978-249-7934
Mailing Address - Fax:978-249-2486
Practice Address - Street 1:584 MAIN ST
Practice Address - Street 2:ROOM 1
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-1824
Practice Address - Country:US
Practice Address - Phone:978-249-7934
Practice Address - Fax:978-249-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11067Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N