Healthcare Provider Details

I. General information

NPI: 1174513071
Provider Name (Legal Business Name): NASHOBA VALLEY HEALTHCARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GROTON RD
AYER MA
01432-1168
US

IV. Provider business mailing address

200 GROTON RD
AYER MA
01432-1168
US

V. Phone/Fax

Practice location:
  • Phone: 978-784-9325
  • Fax: 978-784-9599
Mailing address:
  • Phone: 978-784-9325
  • Fax: 978-784-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUANN SWANEY
Title or Position: DIRECTOR
Credential:
Phone: 978-784-9325