1336120047 NPI number — ATHOL MEMORIAL HOSPITAL INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336120047 NPI number — ATHOL MEMORIAL HOSPITAL INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHOL MEMORIAL HOSPITAL INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ATHOL MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336120047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 GREEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDNER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01440-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-632-3420
Provider Business Mailing Address Fax Number:
978-630-6596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2033 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHOL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-249-3511
Provider Business Practice Location Address Fax Number:
978-249-2651
Provider Enumeration Date:
11/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
978-630-6157

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084F0202X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: 2226 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 050 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 2226 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110024479B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200127 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222000301 . This is a "BCBS OF MA INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 22Z303 . This is a "MEDICARE SWING BED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222000310 . This is a "BCBS OF MA OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002244 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22Z303 . This is a "MCRSWING BED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110024479C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".