1629010947 NPI number — DR. BRETT C HYNNINEN M.D.

Table of content: DR. BRETT C HYNNINEN M.D. (NPI 1629010947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629010947 NPI number — DR. BRETT C HYNNINEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYNNINEN
Provider First Name:
BRETT
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1629010947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
271 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01089-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-785-1153
Provider Business Mailing Address Fax Number:
413-781-4951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 FEDERAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-774-7979
Provider Business Practice Location Address Fax Number:
413-775-0222
Provider Enumeration Date:
06/12/2006

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: 208100000X , with the licence number:  161095 , 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: 3199975 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25255 . This is a "HNE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 406529 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 80558 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J21646 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001519 . This is a "MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com