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General NPI Number Information
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NPI Number | 1629358767
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S HEART CENTER OF WESTERN MASSACHUSETTS, LLC
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Dates
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Enumeration Date | 08/21/2011
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 1754 NORTHAMPTON ST
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City | HOLYOKE
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State | MA
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Zip | 01040-1947
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Country | US
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Telephone | 413-315-3117
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Fax | 662-292-7678
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Provider Business Mailing Address
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Address Line | 1754 NORTHAMPTON ST
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City | HOLYOKE
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State | MA
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Zip | 01040-1947
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Country | US
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Telephone | 413-315-3117
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Fax | 413-585-5122
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL WILLERS
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Credential | M.D.
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Telephone | 413-315-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 237999
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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