1689714040 NPI number — BERKSHIRE OSTEOPATHIC HEALTH, LLC

Table of content: (NPI 1689714040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689714040 NPI number — BERKSHIRE OSTEOPATHIC HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKSHIRE OSTEOPATHIC HEALTH, LLC
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:
1689714040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 SUMMER ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-442-0085
Provider Business Mailing Address Fax Number:
413-464-9143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-442-0085
Provider Business Practice Location Address Fax Number:
413-464-9143
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMAN
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MA AND OFFICE MANAGER
Authorized Official Telephone Number:
413-442-0085

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  233633 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 233633 , 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: M19088 . This is a "BCBS ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9768190 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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