Organization
LIBERTY STREET FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M CHADBOURNE MD (OWNER)
(413) 746-4800
Entity
Organization
Contact information
Practice address
125 LIBERTY ST, SUITE 206, SPRINGFIELD, MA 01103-1114
(413) 746-4800
Mailing address
125 LIBERTY ST, SUITE 206, SPRINGFIELD, MA 01103-1114
(413) 746-4800
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
59098
MA
Other
Enumeration date
01/02/2007
Last updated
08/22/2020
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