Healthcare Provider Details

I. General information

NPI: 1770526527
Provider Name (Legal Business Name): UMASS MEMORIAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINCOLN ST
WORCESTER MA
01605-2011
US

IV. Provider business mailing address

650 LINCOLN ST
WORCESTER MA
01605-2011
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-0052
  • Fax: 508-754-5342
Mailing address:
  • Phone: 508-754-0052
  • Fax: 508-754-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0607193
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. MARY MANNING STONE
Title or Position: DIRECTOR OF OPERATIONS
Credential: MSN
Phone: 508-754-0052