Provider Demographics
NPI:1174512727
Name:CLIPPER CARDIOVASCULAR ASSOCIATES, INC
Entity type:Organization
Organization Name:CLIPPER CARDIOVASCULAR ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-237-7760
Mailing Address - Street 1:112A PARKER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4008
Mailing Address - Country:US
Mailing Address - Phone:878-462-1110
Mailing Address - Fax:978-462-3889
Practice Address - Street 1:112A PARKER ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4008
Practice Address - Country:US
Practice Address - Phone:978-462-1110
Practice Address - Fax:978-462-3889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLIPPER CARDIOVASCULAR ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30214198Medicaid
MA9744011Medicaid
MAM18764OtherBCBS OF MASS
NH9788506Medicaid
MAM21798Medicare PIN
NH9788506Medicaid