Provider Demographics
NPI:1528358249
Name:PEDIATRICS WEST
Entity Type:Organization
Organization Name:PEDIATRICS WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:X
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPNP
Authorized Official - Phone:978-577-0437
Mailing Address - Street 1:133 LITTLETON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3115
Mailing Address - Country:US
Mailing Address - Phone:978-577-0437
Mailing Address - Fax:978-692-4276
Practice Address - Street 1:133 LITTLETON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3115
Practice Address - Country:US
Practice Address - Phone:978-577-0437
Practice Address - Fax:978-692-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
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MA1306931019OtherNPI NUMBER