Provider Demographics
NPI:1447282579
Name:UMASS MEMORIAL HEALTH CARE
Entity type:Organization
Organization Name:UMASS MEMORIAL HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MANNING
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:508-754-0052
Mailing Address - Street 1:650 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2011
Mailing Address - Country:US
Mailing Address - Phone:508-754-0052
Mailing Address - Fax:508-754-5342
Practice Address - Street 1:650 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2011
Practice Address - Country:US
Practice Address - Phone:508-754-0052
Practice Address - Fax:508-754-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0607185Medicaid
MA0607185Medicaid