Provider Demographics
NPI:1619336500
Name:PIONEER VALLEY ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:PIONEER VALLEY ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:H
Authorized Official - Last Name:TWYEFFORT
Authorized Official - Suffix:III
Authorized Official - Credentials:CPO
Authorized Official - Phone:413-788-9655
Mailing Address - Street 1:138 DOTY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1310
Mailing Address - Country:US
Mailing Address - Phone:413-788-9655
Mailing Address - Fax:413-732-0828
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-445-5034
Practice Address - Fax:413-443-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0282580001OtherMEDICARE PTAN
MA1520008Medicaid