MEDICARE: ATHOL MEMORIAL HOSPITAL INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	2036	MA
2	207P00000X	Emergency Medicine Physician	2036	MA
3	207Q00000X	Family Medicine Physician	2036	MA
4	207RC0000X	Cardiovascular Disease Physician	2036	MA
5	2084F0202X	Forensic Psychiatry Physician	2036	MA
6	2084P0805X	Geriatric Psychiatry Physician	2036	MA
7	261QM2500X	Medical Specialty Clinic/Center	2226	MA
8	282N00000X	General Acute Care Hospital	2036	MA
9	282NC0060X	Critical Access Hospital	050	MA
10	363A00000X	Physician Assistant	2036	MA
11	363L00000X	Nurse Practitioner	2036	MA
12	363LA2100X	Acute Care Nurse Practitioner	2036	MA
13	363LF0000X	Family Nurse Practitioner	2036	MA
14	282NC0060X	Critical Access Hospital	2226	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	22Z303	OTHER	MA	MEDICARE SWING BED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2222000301	OTHER	MA	BCBS OF MA INPATIENT
5	2222000310	OTHER	MA	BCBS OF MA OUTPATIENT
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	22Z303	OTHER	MA	MCRSWING BED
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336120047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHOL MEMORIAL HOSPITAL INCORPORATED

Provider Business Mailing Address
First Line	:	242 GREEN ST
Second Line	:
City	:	GARDNER
State	:	MA
Zip	:	01440-1336
Country	:	US
Telephone Number	:	978-632-3420
Fax Number	:	978-630-6596

Provider Business Practice Location Address
First Line	:	2033 MAIN STREET
Second Line	:
City	:	ATHOL
State	:	MA
Zip	:	01331
Country	:	US
Telephone Number	:	978-249-3511
Fax Number	:	978-249-2651

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS J SULLIVAN
Credential	:
Telephone Number	:	978-630-6157

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/08/2023

Similar Medicare Providers

1508864760 — MARY M DJAFERIS F.N.P.
Practice Location Address:

201 S MAIN ST
ATHOL, MA
01331-2102

Practice Phone: 978-249-0099
Practice Fax: 978-249-7227

1225036486 — KRISTIN A MCCARTHY F.N.P
Practice Location Address:

201 S MAIN ST
ATHOL, MA
01331-2102

Practice Phone: 978-249-0099
Practice Fax: 978-249-7227

1588664247 — TIMOTHY E SOULE-REGINE MD
Practice Location Address:

201 S MAIN ST , STE 1
ATHOL, MA
01331-2117

Practice Phone: 978-248-3840
Practice Fax: 978-249-7227

1649266214 — QUABBIN VALLEY CONVALESCENT CENTER,INC.
Practice Location Address:

821 DANIEL SHAYS HWY
ATHOL, MA
01331-9609

Practice Phone: 978-249-3717
Practice Fax: 978-249-7700

1144216946 — OSAMA A. AL-MASRI M.D.
Practice Location Address:

80 MECHANIC ST , 1:4
ATHOL, MA
01331-3534

Practice Phone: 978-249-5668
Practice Fax: 978-249-5669

1558358135 — YOGENDRA K. THAKER M.D.
Practice Location Address:

80 MECHANIC ST
ATHOL, MA
01331-3534

Practice Phone: 978-249-2347
Practice Fax: 978-249-6333

1982691333 — MARK P. WU M.D.
Practice Location Address:

2033 MAIN ST
ATHOL, MA
01331-3535

Practice Phone: 978-249-3511
Practice Fax: 978-249-7666

Directions to “ATHOL MEMORIAL HOSPITAL INCORPORATED ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.