Provider Demographics
NPI:1053559740
Name:MWA, PC
Entity type:Organization
Organization Name:MWA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUNSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-789-8019
Mailing Address - Street 1:232 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1838
Mailing Address - Country:US
Mailing Address - Phone:413-789-5178
Mailing Address - Fax:413-789-8034
Practice Address - Street 1:70 POST OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095
Practice Address - Country:US
Practice Address - Phone:413-598-7770
Practice Address - Fax:413-599-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782613Medicaid
MA9782613Medicaid
MAM20454Medicare PIN