1881615532 NPI number — VASCULAR SERVICES OF WESTERN NEW ENGLAND, 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 1881615532 NPI number — VASCULAR SERVICES OF WESTERN NEW ENGLAND, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR SERVICES OF WESTERN NEW ENGLAND, 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:
1881615532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-784-0900
Provider Business Mailing Address Fax Number:
413-781-5035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 CAREW ST
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01104-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-736-4391
Provider Business Practice Location Address Fax Number:
413-736-4917
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
413-784-0900

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9784187 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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