Organization Name: | MVNE 1 PC |
NPI Number: | 1164797957 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELISSA NELSON (PROJECT MANAGER) |
Mailing Address: | 136 Dwight Road Medvest Llc Longmeadow |
State: | MA US |
Postal Code: | 011063317 |
Phone Number: | 4137543305 |
Fax Number: | 4135653182 |
NPI Enumeration Date: | 03/13/2012 |
NPI Last Update Date: | 03/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |