Healthcare Provider Details

I. General information

NPI: 1043655897
Provider Name (Legal Business Name): SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST. SUITE 208
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

3640 MAIN ST STE 2018
SPRINGFIELD MA
01107-1145
US

V. Phone/Fax

Practice location:
  • Phone: 413-253-2767
  • Fax: 413-253-9767
Mailing address:
  • Phone: 413-253-2767
  • Fax: 413-253-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number50228
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number80036
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00527
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number236642
License Number StateMA

VIII. Authorized Official

Name: GEORGE F HOWARD III
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 413-253-2767