MEDICARE: TOWN OF DRACUT, BOARD OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1225048895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF DRACUT, BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	11 SPRING PARK AVE
Second Line	:	TOWN HALL ANNEX
City	:	DRACUT
State	:	MA
Zip	:	01826-3829
Country	:	US
Telephone Number	:	978-453-8162
Fax Number	:	978-453-9320

Provider Business Practice Location Address
First Line	:	11 SPRING PARK AVE
Second Line	:	TOWN HALL ANNEX
City	:	DRACUT
State	:	MA
Zip	:	01826-3829
Country	:	US
Telephone Number	:	978-453-8162
Fax Number	:	978-453-9320

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	EVAN N THEMELES
Credential	:
Telephone Number	:	978-453-8162

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/22/2020

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