Provider Demographics
NPI:1164797957
Name:MVNE 1 PC
Entity Type:Organization
Organization Name:MVNE 1 PC
Other - Org Name:DOCTORS EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-754-3305
Mailing Address - Street 1:18 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3317
Mailing Address - Country:US
Mailing Address - Phone:413-781-0100
Mailing Address - Fax:
Practice Address - Street 1:136 DWIGHT ROAD
Practice Address - Street 2:MEDVEST LLC
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-3317
Practice Address - Country:US
Practice Address - Phone:413-754-3305
Practice Address - Fax:413-565-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care