Provider Demographics
NPI:1083776140
Name:HOLYOKE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:HOLYOKE MEDICAL CENTER, INC.
Other - Org Name:HOLYOKE HOSPITAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-534-2567
Mailing Address - Street 1:575 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-534-2805
Mailing Address - Fax:413-534-2752
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-534-2805
Practice Address - Fax:413-534-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2145261QM0850X, 261QM0855X, 261QM1300X, 273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200798Medicaid
MA110026773COtherMMIS ID # INPATIENT MENTAL HEALTH
MA110026773DOtherMMIS ID # OUTPATIENT MENTAL HEALTH
MA1001647Medicaid
MA110026773BOtherMMIS ID# OUTPATIENT
MA110026773AOtherMMIS ID # INPT
MA110026773DOtherMMIS ID # OUTPATIENT MENTAL HEALTH
MA220024Medicare PIN
MA1200798Medicaid