1164758439 NPI number — NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS GROUP

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 1164758439 NPI number — NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS GROUP
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:
6
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:
1164758439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 HOSPITAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ADAMS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01247-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-664-5999
Provider Business Mailing Address Fax Number:
413-663-7257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NORTH ADAMS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01247-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-664-5999
Provider Business Practice Location Address Fax Number:
413-663-7257
Provider Enumeration Date:
10/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CALWAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP PHYSICIANS SERVICES AND BUSINES
Authorized Official Telephone Number:
413-664-5508

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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