Provider Demographics
NPI:1457880213
Name:KIDNEY CARE AND TRANSPLANT SERVICES OF NEW ENGLAND, PC
Entity type:Organization
Organization Name:KIDNEY CARE AND TRANSPLANT SERVICES OF NEW ENGLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-733-0010
Mailing Address - Street 1:354 BIRNIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1109
Mailing Address - Country:US
Mailing Address - Phone:413-733-0010
Mailing Address - Fax:413-507-0343
Practice Address - Street 1:51 LOCUST ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2045
Practice Address - Country:US
Practice Address - Phone:413-585-5703
Practice Address - Fax:413-585-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120889AMedicaid