Healthcare Provider Details

I. General information

NPI: 1831461086
Provider Name (Legal Business Name): UMASS MEMORIAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N STE AC1.033
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

55 LAKE AVE N SUITE AC1.033
WORCESTER MA
01655-0002
US

V. Phone/Fax

Practice location:
  • Phone: 888-639-3988
  • Fax: 866-344-0186
Mailing address:
  • Phone: 888-639-3988
  • Fax: 866-344-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89822
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SMITH
Title or Position: DIRECTOR, SPECIALTY PHARMACY
Credential:
Phone: 508-740-8131