Healthcare Provider Details

I. General information

NPI: 1134323603
Provider Name (Legal Business Name): ST ANNE'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S MAIN ST
FALL RIVER MA
02724-2820
US

IV. Provider business mailing address

1010 S MAIN ST
FALL RIVER MA
02724-2820
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-5290
  • Fax: 508-235-5352
Mailing address:
  • Phone: 508-235-5290
  • Fax: 508-235-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72651
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number156889
License Number StateMA

VIII. Authorized Official

Name: JOHN J HASKELL
Title or Position: MANAGER
Credential:
Phone: 401-624-9030