Provider Demographics
NPI:1154495422
Name:ST JOHNS EMERGENCY ASSOC
Entity Type:Organization
Organization Name:ST JOHNS EMERGENCY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:N
Authorized Official - Last Name:GORLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-453-3022
Mailing Address - Street 1:1230 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850
Mailing Address - Country:US
Mailing Address - Phone:978-453-3022
Mailing Address - Fax:978-453-9330
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:SAINTS MEDICAL CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-458-1411
Practice Address - Fax:978-453-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784713Medicaid
MAM17128OtherBLUE SHIELD
MAM20642Medicare ID - Type Unspecified