Provider Demographics
NPI:1134227721
Name:COMPREHENSIVE FAMILY MEDICAL CARE,PC
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY MEDICAL CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:BEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-733-7900
Mailing Address - Street 1:PO BOX 10417
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01041-2017
Mailing Address - Country:US
Mailing Address - Phone:413-540-0150
Mailing Address - Fax:413-540-0159
Practice Address - Street 1:120 MAPLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2203
Practice Address - Country:US
Practice Address - Phone:413-733-7900
Practice Address - Fax:413-733-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074263AMedicaid
MA110074263AMedicaid