Provider Demographics
NPI:1750562765
Name:SPRINGFIELD INTERNATIONAL HEALTH CENTER
Entity type:Organization
Organization Name:SPRINGFIELD INTERNATIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PUNYAMURTULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KISHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-383-6567
Mailing Address - Street 1:760 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1614
Mailing Address - Country:US
Mailing Address - Phone:413-214-7486
Mailing Address - Fax:413-214-7499
Practice Address - Street 1:11 KENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7901
Practice Address - Country:US
Practice Address - Phone:617-383-6567
Practice Address - Fax:617-383-6664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVENTIVE MEDICINE ASSOCIATES,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty