1134227721 NPI number — COMPREHENSIVE FAMILY MEDICAL CARE,PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134227721 NPI number — COMPREHENSIVE FAMILY MEDICAL CARE,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE FAMILY MEDICAL CARE,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1134227721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10417
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01041-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-540-0150
Provider Business Mailing Address Fax Number:
413-540-0159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-733-7900
Provider Business Practice Location Address Fax Number:
413-733-7905
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEM
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
HERNANDEZ
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
413-733-7900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35779 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110074263A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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