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General NPI Number Information
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NPI Number | 1295533206
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICIAN GROUP MASSACHUSETTS PLLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 45 LOWER WESTFIELD RD
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City | HOLYOKE
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State | MA
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Zip | 01040-2747
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Country | US
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Telephone | 413-315-4100
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Fax | 844-440-2328
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Provider Business Mailing Address
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Address Line | PO BOX 744577
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City | ATLANTA
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State | GA
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Zip | 30374-4577
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Country | US
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Telephone | 678-967-5599
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Fax | 844-440-2328
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Authorized Official
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Title or Position | CEO
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Name | PAUL MILLER
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Credential |
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Telephone | 678-967-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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