Provider Demographics
NPI:1720131642
Name:TOWN OF WESTPORT
Entity Type:Organization
Organization Name:TOWN OF WESTPORT
Other - Org Name:WESTPORT FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEGENDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-636-1110
Mailing Address - Street 1:PO BOX 3470
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-0703
Mailing Address - Country:US
Mailing Address - Phone:508-672-0721
Mailing Address - Fax:508-672-0287
Practice Address - Street 1:85 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4020
Practice Address - Country:US
Practice Address - Phone:508-672-0721
Practice Address - Fax:508-672-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1709453Medicaid
802185OtherTUFTS HEALTH PLAN
S014372OtherCHAMPUSTRICARE
000000024886OtherBMC HEALTHNET PLAN
MA0021568OtherNEIGHBORHOOD HEALTH PLAN
RI23853-1OtherBCBS OF RI
037959OtherBLUE CROSS BLUE SHIELD MA
81-00042OtherUNITED HEALTHCARE
700107OtherHARVARD PILGRIM HEALTHCAR
RI23853-1OtherBCBS OF RI