Provider Demographics
NPI:1851475339
Name:KEVIN SNOW D.O., LLC
Entity Type:Organization
Organization Name:KEVIN SNOW D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:413-533-2452
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-0489
Mailing Address - Country:US
Mailing Address - Phone:413-525-9445
Mailing Address - Fax:413-525-9406
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-533-2452
Practice Address - Fax:413-533-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA213952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18771OtherBLUE CROSS OF MASSACHUSET