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General NPI Number Information
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NPI Number | 1942693759
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Entity Type | Organization
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Legal Business Name | PIONEER VALLEY WOUND CARE LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 246 MAPLE ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3235
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Country | US
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Telephone | 508-217-4440
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Fax | 866-574-9474
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Provider Business Mailing Address
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Address Line | 84 DOANE RD
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City | WARE
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State | MA
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Zip | 01082-9387
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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 | PHYSICIAN
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Name | TYLER WEST
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Credential |
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Telephone | 413-588-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | MA
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