Individual ProviderLouis Patrick FavataPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address140 High St., Springfield, MA 01199(413) 794-2511(413) 794-5700PECOS EnrollmentBased on the most recent information from CMS, provider Louis Patrick Favata does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1518947159Provider TypeIndividualFull NameFavata, Louis PatrickTitleMr.CredentialPA-CGenderMaleSole ProprietorNoEnumeration Date1/19/2006Last Updated3/3/2010Contact InformationPractice LocationPractice Address140 High St., Springfield, MA 01199Phone(413) 794-2511Fax(413) 794-2272Mailing LocationMailing Address280 Chestnut St., Springfield, MA 01199Phone(413) 794-5700FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense1505MassachusettsProvider IdentifiersIDDescriptionIssuerID1505DescriptionOtherIssuerLICMassachusetts