1689670259 NPI number — MOUNT AUBURN HOSPITAL

Table of content: (NPI 1689670259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689670259 NPI number — MOUNT AUBURN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT AUBURN HOSPITAL
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:
1689670259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 MOUNT AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-492-3500
Provider Business Mailing Address Fax Number:
617-499-5422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 MOUNT AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-492-3500
Provider Business Practice Location Address Fax Number:
617-499-5422
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOLEN
Authorized Official First Name:
TONI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
617-499-5654

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2898 , 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)

  • Identifier: 2222000230 . This is a "SURG.DAY CARE BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900023 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1201298 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222000205 . This is a "PSYCH BLUE CROSS PROV. NU" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 50-40078 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 996324 . This is a "NETWORK HEALTH SERVICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1099876 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007057 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222000210 . This is a "OUTPAT.BLUE CROSS PROV.NU" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900749 . This is a "OUTPAT.TUFTS AFFIL. H.P." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012149 . This is a "AETNA/US HEALTHCARE PROV." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222000201 . This is a "INPAT.BLUE CROSS PROV.NUM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 245718 . This is a "MAGELLAN OUTPATIENT PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900037 . This is a "INPAT.SECURE HORIZONS PRO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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