Provider Demographics
NPI:1912105123
Name:TOWN OF SPENCER
Entity Type:Organization
Organization Name:TOWN OF SPENCER
Other - Org Name:TOWN OF SPENCER BOARD OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD OF HEALTH AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-885-7500
Mailing Address - Street 1:157 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562
Mailing Address - Country:US
Mailing Address - Phone:508-885-7500
Mailing Address - Fax:508-885-7519
Practice Address - Street 1:157 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562
Practice Address - Country:US
Practice Address - Phone:508-885-7500
Practice Address - Fax:508-885-7519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF SPENCER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11084Medicare PIN