Provider Demographics
NPI:1629358767
Name:THE CHILDREN'S HEART CENTER OF WESTERN MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:THE CHILDREN'S HEART CENTER OF WESTERN MASSACHUSETTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-315-3117
Mailing Address - Street 1:1754 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1947
Mailing Address - Country:US
Mailing Address - Phone:413-315-3117
Mailing Address - Fax:413-585-5122
Practice Address - Street 1:1754 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1947
Practice Address - Country:US
Practice Address - Phone:413-315-3117
Practice Address - Fax:662-292-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080P0202X
MA237999261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty