Basic Information
| Provider Information | |||||||||
| NPI: | 1831151455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UMASS MEMORIAL MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 LAKE AVENUE | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
| FaxNumber: | 5083340495 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 LAKE AVENUE | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
| FaxNumber: | 5083340495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | MELGAR | ||||||||
| AuthorizedOfficialFirstName: | SERGIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 5083340530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N/A | MA | Y | Hospitals | General Acute Care Hospital |
No ID Information.