Basic Information
| Provider Information | |||||||||
| NPI: | 1689670259 | ||||||||
| 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: | 06/28/2005 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | CLOUGH | ||||||||
| AuthorizedOfficialFirstName: | JEANETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| 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 | 282N00000X | 2898 | MA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0007057 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 2222000210 | 01 | MA | OUTPAT.BLUE CROSS PROV.NU | OTHER | 2222000230 | 01 | MA | SURG.DAY CARE BLUE CROSS | OTHER | 245718 | 01 | MA | MAGELLAN OUTPATIENT PSYCH | OTHER | 996324 | 01 | MA | NETWORK HEALTH SERVICES | OTHER | 0012149 | 01 | MA | AETNA/US HEALTHCARE PROV. | OTHER | 2222000201 | 01 | MA | INPAT.BLUE CROSS PROV.NUM | OTHER | 900749 | 01 | MA | OUTPAT.TUFTS AFFIL. H.P. | OTHER | 2222000205 | 01 | MA | PSYCH BLUE CROSS PROV. NU | OTHER | 900023 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 1201298 | 05 | MA | MEDICAID | 50-40078 | 01 | MA | UNITED HEALTH CARE | OTHER | 900037 | 01 | MA | INPAT.SECURE HORIZONS PRO | OTHER | 1099876 | 05 | MA | MEDICAID |