1770738262 NPI number — WING MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1770738262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770738262 NPI number — WING MEMORIAL HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WING MEMORIAL 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:
WING MEMORIAL HOSPITAL & MEDICAL CENTERS/CHIROPRACTIC SERVICES
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:
1770738262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WRIGHT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01069-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-283-7651
Provider Business Mailing Address Fax Number:
413-284-5117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WRIGHT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01069-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-283-7651
Provider Business Practice Location Address Fax Number:
413-284-5117
Provider Enumeration Date:
11/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALLICON
Authorized Official First Name:
KEARY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
413-284-5302

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  835 , 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: 2222003013 . This is a "BLUE CROSS OUTPT. MEDICAL CENTERS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0608149 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220030 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2222003010 . This is a "BLUE CROSS - HOSPITAL OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0608157 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001191 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1202057 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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