Provider Demographics
NPI:1043655897
Name:SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS LLC
Entity type:Organization
Organization Name:SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:413-253-2767
Mailing Address - Street 1:3640 MAIN ST STE 2018
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-253-2767
Mailing Address - Fax:413-253-9767
Practice Address - Street 1:3640 MAIN ST.
Practice Address - Street 2:SUITE 208
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-253-2767
Practice Address - Fax:413-253-9767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP MEDICINE SERVICES OF WESTERN MASSACHUSETTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-07
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA502282084N0400X
MA800362084S0012X
MA261QS1200X
CTPA00527363AM0700X
MA236642363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty