1487608485 NPI number — SPECTRUM HEALTH SYSTEMS, INC

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 1487608485 NPI number — SPECTRUM HEALTH SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM HEALTH SYSTEMS, INC
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:
Provider Other Organization Name Type Code:
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:
1487608485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MECHANIC ST.
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-792-5400
Provider Business Mailing Address Fax Number:
508-831-0074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-854-3320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
508-792-5400

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 988189 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2220002001 . This is a "BCBS OF MA SUBSTANCE ABUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 690527 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18684 . This is a "BCBS OF MA MENTAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1002900 . This is a "BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1306421 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1308785 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 903163 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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