Provider Demographics
NPI:1871530030
Name:TOWN OF MENDON
Entity type:Organization
Organization Name:TOWN OF MENDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BUCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-473-5330
Mailing Address - Street 1:9 MAIN ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-1660
Mailing Address - Country:US
Mailing Address - Phone:508-476-9740
Mailing Address - Fax:508-476-9748
Practice Address - Street 1:8 MORRISON DR
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1346
Practice Address - Country:US
Practice Address - Phone:508-473-5330
Practice Address - Fax:508-473-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ00352OtherBCBS PROVIDER NUMBER
MA1720325Medicaid
MAAM0148Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER