1659505519 NPI number — MR. JAMES HAAS C.O.

Table of content: MR. JAMES HAAS C.O. (NPI 1659505519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659505519 NPI number — MR. JAMES HAAS C.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAAS
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659505519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 BIRNIE AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-737-2404
Provider Business Mailing Address Fax Number:
413-733-1389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 SOUTH ST
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-6988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-442-0017
Provider Business Practice Location Address Fax Number:
413-442-0020
Provider Enumeration Date:
05/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  CO004133 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1540408 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3048436 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009994 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15121 . This is a "HNE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000006888 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008938 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 553174 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 734427 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803119 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65955037 . This is a "VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701312 . This is a "HARVARD PLIGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 833821 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 360154 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 43871 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 475460 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S009509 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".