Basic Information
| Provider Information | |||||||||
| NPI: | 1760731137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCOUNTABLE CARE CLINICAL SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | HENDREN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4137342000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.