Provider Demographics
NPI:1750135216
Name:PRIMARY CARE OF THE BROOKFIELDSPLLC
Entity type:Organization
Organization Name:PRIMARY CARE OF THE BROOKFIELDSPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:774-227-3556
Mailing Address - Street 1:221 E MAIN ST # 5011
Mailing Address - Street 2:
Mailing Address - City:EAST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01515-1639
Mailing Address - Country:US
Mailing Address - Phone:774-227-3556
Mailing Address - Fax:508-213-9008
Practice Address - Street 1:82 WENDELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7066
Practice Address - Country:US
Practice Address - Phone:774-227-3556
Practice Address - Fax:508-213-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care