Provider Demographics
NPI:1205994365
Name:HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Entity type:Organization
Organization Name:HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATENAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-314-6203
Mailing Address - Street 1:354 BIRNIE AVE
Mailing Address - Street 2:ATTN: PAM GREANEY
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1108
Mailing Address - Country:US
Mailing Address - Phone:413-314-6203
Mailing Address - Fax:413-733-5235
Practice Address - Street 1:95 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1011
Practice Address - Country:US
Practice Address - Phone:413-732-6660
Practice Address - Fax:413-732-6166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00371177OtherRR MEDICARE PTAN - IMAG CTR
MA327105OtherMEDICARE PIN - IMAG CTR
MA327105OtherRR MEDICARE PIN - IMAG CTR