Provider Demographics
NPI:1336363217
Name:SPRINGFIELD INTERNATIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:SPRINGFIELD INTERNATIONAL HEALTH CENTER
Other - Org Name:PREVENTIVE MEDICINE ASSOC. INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-447-2146
Mailing Address - Street 1:59 TEMPLE PL STE 662
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1307
Mailing Address - Country:US
Mailing Address - Phone:617-447-2146
Mailing Address - Fax:617-259-1627
Practice Address - Street 1:760 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1614
Practice Address - Country:US
Practice Address - Phone:413-214-7486
Practice Address - Fax:413-214-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty