Provider Demographics
NPI:1295884500
Name:PIONEER VALLEY ENT SURGEONS LLC
Entity type:Organization
Organization Name:PIONEER VALLEY ENT SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-586-7100
Mailing Address - Street 1:15 STRAW AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1464
Mailing Address - Country:US
Mailing Address - Phone:413-586-7100
Mailing Address - Fax:
Practice Address - Street 1:15 STRAW AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1464
Practice Address - Country:US
Practice Address - Phone:413-586-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9733761Medicaid
MAM21480Medicare ID - Type Unspecified