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General NPI Number Information
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NPI Number | 1083996920
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Entity Type | Organization
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Legal Business Name | THAYERCARE AT WARE, LLC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 40 CHESTNUT ST
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City | WARE
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State | MA
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Zip | 01082-1574
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Country | US
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Telephone | 413-277-9503
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Fax | 413-277-9506
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | HADLEY
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State | MA
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Zip | 01035-0034
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Country | US
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Telephone | 413-277-9503
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Fax | 413-277-9506
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. WALTER D. THAYER
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Credential |
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Telephone | 413-218-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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