Healthcare Provider Details

I. General information

NPI: 1245564988
Provider Name (Legal Business Name): TOWN OF SHUTESBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOLEYVILLE RD BOX 216
SHUTESBURY MA
01072-0216
US

IV. Provider business mailing address

BOX 216
SHUTESBURY MA
01072-0216
US

V. Phone/Fax

Practice location:
  • Phone: 413-259-2122
  • Fax:
Mailing address:
  • Phone: 413-259-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM ELLIOT
Title or Position: CHAIR, BOARD OF HEALTH
Credential:
Phone: 413-259-2122