Provider Demographics
NPI:1477757615
Name:ST ANNE'S HOSPITAL
Entity Type:Organization
Organization Name:ST ANNE'S HOSPITAL
Other - Org Name:DBA JORGE M ANDRADE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-624-9030
Mailing Address - Street 1:1010 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-2820
Mailing Address - Country:US
Mailing Address - Phone:508-235-5466
Mailing Address - Fax:508-235-5477
Practice Address - Street 1:1010 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2820
Practice Address - Country:US
Practice Address - Phone:508-235-5466
Practice Address - Fax:508-235-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3154955Medicaid
MA220020Medicare PIN
MAJ14983Medicare PIN
MA3154955Medicaid