Avalon Medical Spa

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

1138975 Issued in MA

Legal business name

AVALON MEDICAL SPA

Practice address

651 Orchard St Ste 202
New Bedford, MA 02744-1052

Phone

(774) 202-7049

Fax

(774) 202-2839

NPI assigned

Sep 12, 2011

Last updated

Sep 12, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. William L Thornson, PA-C

Title

Owner

Phone

(774) 202-7049

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1366724825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 ORCHARD ST STE 202",
            "city": "NEW BEDFORD",
            "state": "MA",
            "postal_code": "027441052",
            "telephone_number": "774-202-7049",
            "fax_number": "774-202-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 ORCHARD ST STE 202",
            "city": "NEW BEDFORD",
            "state": "MA",
            "postal_code": "027441052",
            "telephone_number": "774-202-7049",
            "fax_number": "774-202-2839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON MEDICAL SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "THORNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-202-7049",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MA",
            "license": "1138975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in New Bedford, MA by specialty
• Health Service Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.