Basic Information
| Provider Information | |||||||||
| NPI: | 1851475339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEVIN SNOW D.O., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 489 | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010280489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135259445 | ||||||||
| FaxNumber: | 4135259406 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010406603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135332452 | ||||||||
| FaxNumber: | 4135333624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4135332452 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA213952 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | M18771 | 01 | MA | BLUE CROSS OF MASSACHUSET | OTHER |