Provider Demographics
NPI:1124185616
Name:MERRIMACK VALLEY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-206-6198
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21730OtherFALLON
MA29998OtherAETNA US HEALTHCARE
MA981083OtherNETWORK HEALTH
MA0007697OtherNETWORK HEALTH
MA0489237OtherCIGNA HEALTHSOURCE
MA708812OtherTUFTS HP SECURE HORIZON
MA018269OtherBCBS
MA0007697OtherNEIGHBORHOOD HEALTH PLAN
MA608297OtherHARVARD PILGRIM HEALTH CA
MA114493500OtherUS DEPT OF LABOR OWCP
MA1532464Medicaid
MA29998OtherAETNA US HEALTHCARE
MA470000608Medicare ID - Type UnspecifiedRAILROAD