Provider Demographics
NPI:1780741207
Name:TOWN OF SHIRLEY
Entity type:Organization
Organization Name:TOWN OF SHIRLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-425-2600
Mailing Address - Street 1:7 KEADY WAY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2630
Mailing Address - Country:US
Mailing Address - Phone:978-425-2600
Mailing Address - Fax:978-234-7118
Practice Address - Street 1:7 KEADY WAY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2630
Practice Address - Country:US
Practice Address - Phone:978-425-2600
Practice Address - Fax:978-234-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1711229Medicaid
MA038859Medicare ID - Type Unspecified