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General NPI Number Information
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NPI Number | 1447535141
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Entity Type | Organization
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Legal Business Name | PAC ASSOCIATES
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 383 EAST ST
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City | LENOX
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State | MA
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Zip | 01240-2234
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Country | US
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Telephone | 413-881-4066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 115
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City | WEST STOCKBRIDGE
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State | MA
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Zip | 01266-0115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK MANZO
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Credential |
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Telephone | 413-881-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | PA3715
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License Number State | MA
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