1992068381 NPI number — UMASS MEMORIAL MEDICAL CENTER, INC.

Table of content: (NPI 1992068381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992068381 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:
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:
1992068381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 BELMONT ST
Provider Second Line Business Mailing Address:
MEMORIAL CAMPUS
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-421-1990
Provider Business Mailing Address Fax Number:
508-334-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 BELMONT ST
Provider Second Line Business Practice Location Address:
MEMORIAL CAMPUS
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-421-1990
Provider Business Practice Location Address Fax Number:
508-334-6100
Provider Enumeration Date:
06/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUGGINS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP FINANCE/CORP CONTROLLER
Authorized Official Telephone Number:
508-334-0252

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  DS89916 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: DS89818 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110022124Z , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110022124O , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2242319 . This is a "NCPDP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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