Healthcare Provider Details

I. General information

NPI: 1952785156
Provider Name (Legal Business Name): EMERSON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4159
US

IV. Provider business mailing address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4159
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. JAMES STREET
Title or Position: CHEIF OF ANESTHESIA
Credential: M.D
Phone: 978-287-3162