1831461086 NPI number — UMASS MEMORIAL MEDICAL CENTER, INC.

Table of content: (NPI 1831461086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831461086 NPI number — UMASS MEMORIAL MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMASS MEMORIAL MEDICAL CENTER, 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:
UMASS MEMORIAL MEDICAL CENTER SPECIALTY PHARMACY
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:
1831461086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2016
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:
SUITE AC1.033
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:
888-639-3988
Provider Business Mailing Address Fax Number:
866-344-0186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 LAKE AVE N STE AC1.033
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:
01655-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-639-3988
Provider Business Practice Location Address Fax Number:
866-344-0186
Provider Enumeration Date:
02/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, SPECIALTY PHARMACY
Authorized Official Telephone Number:
508-740-8131

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  DS89822 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110093140 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2135484 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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