Healthcare Provider Details

I. General information

NPI: 1487808309
Provider Name (Legal Business Name): HYANNIS ANIMAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ANSEL HALLET RD
WEST YARMOUTH MA
02673-2582
US

IV. Provider business mailing address

102 ANSEL HALLET RD
WEST YARMOUTH MA
02673-2582
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-4521
  • Fax: 508-790-1900
Mailing address:
  • Phone: 508-775-4521
  • Fax: 508-790-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2130
License Number StateMA

VIII. Authorized Official

Name: LAWRENCE E VENEZIA
Title or Position: PRESIDENT
Credential: DVM
Phone: 508-775-4521