Healthcare Provider Details

I. General information

NPI: 1013529502
Provider Name (Legal Business Name): HENRY HEYWOOD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 06/08/2023
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN ST
GARDNER MA
01440-1336
US

IV. Provider business mailing address

242 GREEN ST
GARDNER MA
01440-1373
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-6944
  • Fax:
Mailing address:
  • Phone: 978-630-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: THOMAS J SULLIVAN
Title or Position: CEO
Credential:
Phone: 978-630-6157