=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730614678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2017
-----------------------------------------------------
Last Update Date | 07/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 267 LOCUST ST STE 101
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01062-2770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-253-2627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3640 MAIN ST SUITE 208
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-253-2767
-----------------------------------------------------
Fax | 413-253-9767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | CHRIS LITTLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-253-2767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------