Provider Demographics
NPI:1376827188
Name:SPECTRUM HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:SPECTRUM HEALTH SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-792-5400
Mailing Address - Street 1:10 MECHANIC ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2420
Mailing Address - Country:US
Mailing Address - Phone:508-792-5400
Mailing Address - Fax:508-831-0058
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1937
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:508-797-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2220002001OtherBLUE CROSS BLUE SHEILD
MAM18684OtherBLUE CROSS BLUE SHEILD
MA1308785Medicaid
MA1306421Medicaid
MA1308785Medicaid