Healthcare Provider Details

I. General information

NPI: 1992923486
Provider Name (Legal Business Name): HOLYOKE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

575 BEECH ST
HOLYOKE MA
01040-2223
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2845
  • Fax: 413-540-5053
Mailing address:
  • Phone: 413-534-2845
  • Fax: 413-540-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number214S
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number2145
License Number StateMA

VIII. Authorized Official

Name: MICHAEL J. KOZIOL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 413-534-2567