Organization
PIONEER VALLEY NEPHROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL GILLIS (BILLING MANAGER)
(413) 787-0090
Entity
Organization
Contact information
Practice address
300 STAFFORD ST, SUITE 161, SPRINGFIELD, MA 01104-3581
(413) 787-0090
(413) 787-0089
Mailing address
300 STAFFORD ST, SUITE 161, SPRINGFIELD, MA 01104-3581
(413) 787-0090
(413) 787-0089
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109932
—
CT
05
—
9709312
—
MA
01
—
M17055
BCBS GROUP NUMBER
MA
Enumeration date
06/20/2006
Last updated
01/17/2014
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