Healthcare Provider Details

I. General information

NPI: 1134227721
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY MEDICAL CARE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAPLE ST SUITE 203
SPRINGFIELD MA
01103-2203
US

IV. Provider business mailing address

PO BOX 10417
HOLYOKE MA
01041-2017
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-7900
  • Fax: 413-733-7905
Mailing address:
  • Phone: 413-540-0150
  • Fax: 413-540-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35779
License Number StateMA

VIII. Authorized Official

Name: DR. MARTIN HERNANDEZ BEM
Title or Position: OWNER
Credential: MD
Phone: 413-733-7900