1407827710 NPI number — NORTHEAST HOSPITAL CORPORATION

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 1407827710 NPI number — NORTHEAST HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST HOSPITAL CORPORATION
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:
BEVERLY HOSPITAL
Provider Other Organization Name Type Code:
4
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:
1407827710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 HERRICK STREET
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-922-3000
Provider Business Mailing Address Fax Number:
978-921-7048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 HERRICK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-922-3000
Provider Business Practice Location Address Fax Number:
978-921-7048
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONROY
Authorized Official First Name:
DENIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
978-922-3000

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  15 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1202626 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003306 . This is a "BC INDEM IP PSYCH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 900082 . This is a "TUFTS MCR HMO OUTPAT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 901790 . This is a "TUFTS IP PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000039 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003311 . This is a "BC HMO/PHO PSYCH OP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222003325 . This is a "BC OUTPAT INDEM PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9343 . This is a "AETNA HMO PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BEV2222003311 . This is a "HMO BLUE PSYCH OP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007079 . This is a "NHP PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1898639 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003301 . This is a "BC HMO/PHO PSYCH IP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900082 . This is a "TUFTS OUTPAT PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BEV2222003301 . This is a "HMO BLUE PSYCH IP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 901790 . This is a "TUFTS MCR HMO INPAT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S005394 . This is a "CHAMPUS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 903159 . This is a "HARVARD PILGRIM PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com