Basic Information
| Provider Information | |||||||||
| NPI: | 1689006322 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTFIELD MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NOBLE EXPRESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 W SILVER ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010853678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135623444 | ||||||||
| FaxNumber: | 4135725016 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 UNION ST, STE 101 | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010852658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136427200 | ||||||||
| FaxNumber: | 4135621821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BRYANT | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4135682811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTFIELD MEDICAL CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 9782265 | 05 | MA | MEDICAID | M20759 | 01 | MA | MEDICARE GROUP # | OTHER |