Basic Information
| Provider Information | |||||||||
| NPI: | 1649254491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNT AUBURN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174923500 | ||||||||
| FaxNumber: | 6174995422 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174923500 | ||||||||
| FaxNumber: | 6174995422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLOUGH | ||||||||
| AuthorizedOfficialFirstName: | JEANETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 6174995700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 2898 | MA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 245718 | 01 | MA | MAGELLAN/MA MERIT CLAIMS | OTHER | 900037 | 01 | MA | TUFTS ASSC HLTH PL. INPAT | OTHER | 900749 | 01 | MA | TUFTS ASSC HLTH PL-OUTPAT | OTHER | 996324 | 01 | MA | NETWORK HEALTH PLAN | OTHER | MOU2222000230 | 01 | MA | BLUE X MASTER MEDICAL | OTHER | 1002150 | 01 | MA | BEACON HEALTH-OUTPATIENT | OTHER | 50-40078 | 01 | MA | UNITED HEALTHCARE | OTHER | 0007057 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 0012149 | 01 | MA | AETNA/US HEALTHCARE | OTHER |