Basic Information
| Provider Information | |||||||||
| NPI: | 1205315793 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN MASS PHYSICIAN ASSOCIATES INC | ||||||||
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| OtherOrganizationName: | HOLYOKE MEDICAL GROUP WALK-IN CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 NEW LUDLOW RD | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010204324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135342605 | ||||||||
| FaxNumber: | 4135342661 | ||||||||
| Practice Location | |||||||||
| Address1: | 1962 MEMORIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135523250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2018 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | CANDITO | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF AMBULATORY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4135342622 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY HEALTH SYSTEMS, INC. | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.