Provider Demographics
NPI:1619198959
Name:TOWN OF RANDOLPH
Entity type:Organization
Organization Name:TOWN OF RANDOLPH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TOWN TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-961-0913
Mailing Address - Street 1:1 TURNER LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3927
Mailing Address - Country:US
Mailing Address - Phone:781-961-0924
Mailing Address - Fax:781-961-0927
Practice Address - Street 1:1 TURNER LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3927
Practice Address - Country:US
Practice Address - Phone:781-961-0924
Practice Address - Fax:781-961-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11044Medicare ID - Type UnspecifiedRANDOLPH BOH