Provider Demographics
NPI:1205174745
Name:SPRINGFIELD MEDICAL CARE SYSTEMS INC
Entity type:Organization
Organization Name:SPRINGFIELD MEDICAL CARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/CSO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-885-7629
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-886-3556
Mailing Address - Fax:
Practice Address - Street 1:29 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3060
Practice Address - Country:US
Practice Address - Phone:802-886-3556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
471845OtherMEDICARE PTAN