Provider Demographics
NPI:1366872079
Name:SHELBURNE FAMILY PRACTICE
Entity type:Organization
Organization Name:SHELBURNE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/HEALTHCARE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:413-625-6021
Mailing Address - Street 1:1000 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-9705
Mailing Address - Country:US
Mailing Address - Phone:413-625-6021
Mailing Address - Fax:413-625-6073
Practice Address - Street 1:1000 MOHAWK TRL
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-9705
Practice Address - Country:US
Practice Address - Phone:413-625-6021
Practice Address - Fax:413-625-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181085261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care