=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689714040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERKSHIRE OSTEOPATHIC HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 08/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 SUMMER ST SUITE 301
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-0085
-----------------------------------------------------
Fax | 413-464-9143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 SUMMER ST SUITE 301
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-0085
-----------------------------------------------------
Fax | 413-464-9143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MA AND OFFICE MANAGER
-----------------------------------------------------
Name | MARIA A HOLMAN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 413-442-0085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 233633
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 233633
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------