1700961125 NPI number — SPRINGFIELD PARK VIEW HOSPITAL, LLC

Table of content: (NPI 1700961125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700961125 NPI number — SPRINGFIELD PARK VIEW HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGFIELD PARK VIEW HOSPITAL, LLC
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:
1700961125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 S 4TH ST
Provider Second Line Business Mailing Address:
K-LIVE 5 REIMBURSEMENT
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-596-7300
Provider Business Mailing Address Fax Number:
502-596-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 HUNTOON MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01542-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-892-6000
Provider Business Practice Location Address Fax Number:
508-892-6001
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROTHGERBER
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SR. VICE PRESIDENT OF REIMBURSEMENT
Authorized Official Telephone Number:
502-596-7300

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  2223 , 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: 2222204603 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000021333 . This is a "HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1101871 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 981428 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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