1700855053 NPI number — FAIRVIEW PEDIATRICS

Table of content: (NPI 1700855053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700855053 NPI number — FAIRVIEW PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW PEDIATRICS
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:
1700855053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1176 MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01020-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-593-1333
Provider Business Mailing Address Fax Number:
413-593-1444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1176 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01020-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-593-1333
Provider Business Practice Location Address Fax Number:
413-593-1444
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
413-593-1333

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  205617 , 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: 3209156 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J22280 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 205617 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202357 . This is a "PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01020561MA01 . This is a "BCBS CONN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7859 . This is a "HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 26476 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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