1407827710 NPI number — NORTHEAST HOSPITAL CORPORATION

Table of content: (NPI 1407827710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407827710 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:
1407827710
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:
85 HERRICK STREET
Provider Second Line Business Practice Location Address:
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:
978-922-3000
Provider Business Practice Location Address Fax Number:
978-921-7048
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  15 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1202626 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003306 . This is a "BC INDEM IP PSYCH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 900082 . This is a "TUFTS MCR HMO OUTPAT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 901790 . This is a "TUFTS IP PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000039 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003311 . This is a "BC HMO/PHO PSYCH OP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222003325 . This is a "BC OUTPAT INDEM PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9343 . This is a "AETNA HMO PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BEV2222003311 . This is a "HMO BLUE PSYCH OP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007079 . This is a "NHP PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1898639 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222003301 . This is a "BC HMO/PHO PSYCH IP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900082 . This is a "TUFTS OUTPAT PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BEV2222003301 . This is a "HMO BLUE PSYCH IP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 901790 . This is a "TUFTS MCR HMO INPAT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S005394 . This is a "CHAMPUS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 903159 . This is a "HARVARD PILGRIM PSYCH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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