Provider Demographics
NPI:1407804669
Name:THE LOWELL GENERAL HOSPITAL
Entity Type:Organization
Organization Name:THE LOWELL GENERAL HOSPITAL
Other - Org Name:LOWELL GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-788-7143
Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01853-1819
Mailing Address - Country:US
Mailing Address - Phone:978-937-6000
Mailing Address - Fax:978-788-7822
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6000
Practice Address - Fax:978-788-7822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2040282N00000X
MAMA01148473336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026472CMedicaid
2242321OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA110026472BMedicaid
MA110026472CMedicaid