Provider Demographics
NPI:1073049441
Name:ATHOL MEMORIAL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:ATHOL MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:TULLY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-630-6157
Mailing Address - Street 1:242 GREEN ST
Mailing Address - Street 2:ADMIN ANNEX
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 RESERVOIR DRIVE
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331
Practice Address - Country:US
Practice Address - Phone:978-248-5135
Practice Address - Fax:978-248-5130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHOL MEMORIAL HOSPITAL INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health