1790886091 NPI number — PEDIATRIC SERVICES OF SPRINGFIELD, INC.

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 1790886091 NPI number — PEDIATRIC SERVICES OF SPRINGFIELD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC SERVICES OF SPRINGFIELD, INC.
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:
1790886091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 NORTH MAIN STREET
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
EAST LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-525-1870
Provider Business Mailing Address Fax Number:
413-525-3883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
EAST LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-525-1870
Provider Business Practice Location Address Fax Number:
413-525-3883
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NORDSTROM
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
DNP/OWNER
Authorized Official Telephone Number:
413-525-1870

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  45445 , 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)





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