Provider Demographics
NPI:1326628322
Name:ADVANCED MOBILE PEDIATRICS PLCC
Entity Type:Organization
Organization Name:ADVANCED MOBILE PEDIATRICS PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:413-726-1390
Mailing Address - Street 1:50 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-9756
Mailing Address - Country:US
Mailing Address - Phone:413-726-1390
Mailing Address - Fax:
Practice Address - Street 1:50 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9756
Practice Address - Country:US
Practice Address - Phone:413-726-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No251E00000XAgenciesHome Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110124332Medicaid