Healthcare Provider Details

I. General information

NPI: 1891994042
Provider Name (Legal Business Name): SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST STE 208
SPRINGFIELD MA
01107-1192
US

IV. Provider business mailing address

3640 MAIN ST STE 208
SPRINGFIELD MA
01107-1192
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 TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number80036
License Number StateMA

VIII. Authorized Official

Name: DR. BRIAN SMITH
Title or Position: OWNER
Credential: M.D.
Phone: 413-253-2767