1073658225 NPI number — NORTHEAST HOSPITAL CORPORATION

Table of content: (NPI 1073658225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073658225 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:
Provider Other Organization Name Type Code:
6
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:
1073658225
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:
600 CUMMINGS CENTER
Provider Second Line Business Practice Location Address:
SUITE 176X
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:
978-921-5020
Provider Business Practice Location Address Fax Number:
978-739-4627
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902997 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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