Healthcare Provider Details

I. General information

NPI: 1124091673
Provider Name (Legal Business Name): TOWN OF TEWKSBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TOWN HALL AVE
TEWKSBURY MA
01876-2752
US

IV. Provider business mailing address

19 NORFOLK AVE
SOUTH EASTON MA
02375-1911
US

V. Phone/Fax

Practice location:
  • Phone: 978-640-4410
  • Fax:
Mailing address:
  • Phone: 508-297-2068
  • Fax: 508-297-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3062
License Number StateMA

VIII. Authorized Official

Name: MICHAEL HAZEL
Title or Position: FIRE CHIEF
Credential:
Phone: 978-640-4410