Provider Demographics
NPI:1629020607
Name:PIONEER VALLEY GRAPHICS, PC
Entity Type:Organization
Organization Name:PIONEER VALLEY GRAPHICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-781-5735
Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:413-732-0225
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-732-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782761Medicaid
MAM20542Medicare ID - Type UnspecifiedMEDICARE GROUP #