Basic Information
Provider Information
NPI: 1194735449
EntityType: 2
ReplacementNPI:  
OrganizationName: BODKHE & DICKEY ASSOCIATES, LLC
LastName:  
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Credential:  
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Mailing Information
Address1: PO BOX 910
Address2:  
City: GREENFIELD
State: MA
PostalCode: 013020910
CountryCode: US
TelephoneNumber: 4137728500
FaxNumber: 4137728900
Practice Location
Address1: 51 SANDERSON ST STE 10
Address2:  
City: GREENFIELD
State: MA
PostalCode: 013012739
CountryCode: US
TelephoneNumber: 4137726040
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/09/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DICKEY
AuthorizedOfficialFirstName: JEFFERSON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4137726040
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QA0505X75064MAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine

ID Information
IDTypeStateIssuerDescription
6131801MAHARVARD PILGRIMOTHER
BOJ1214001MABC LOCAL TEAMSTERSOTHER
2047101MABMC HEALTHNETOTHER
032097805MA MEDICAID
07506401MATUFTSOTHER
101141905VT MEDICAID
P0012535101MARR MEDICAREOTHER
07506401MACIGNAOTHER
J1214001MABC/BS MAOTHER
308970305MA MEDICAID


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