1477618957 NPI number — UNIVERSITY OF MASSACHUSETTS

Table of content: (NPI 1477618957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477618957 NPI number — UNIVERSITY OF MASSACHUSETTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MASSACHUSETTS
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:
UMASS MEDICAL SCHOOL
Provider Other Organization Name Type Code:
3
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:
1477618957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 LAKE AVE N
Provider Second Line Business Mailing Address:
UMASS MEDICAL SCHOOL
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01655-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-6537
Provider Business Mailing Address Fax Number:
508-856-8435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 BELMONT ST
Provider Second Line Business Practice Location Address:
WORCESTER RECOVERY CENTER AND HOSPITAL
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01604-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-368-4000
Provider Business Practice Location Address Fax Number:
508-363-1515
Provider Enumeration Date:
12/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CHANCELLOR
Authorized Official Telephone Number:
508-856-2107

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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