Provider Demographics
NPI:1598923625
Name:WING MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:WING MEMORIAL HOSPITAL CORPORATION
Other - Org Name:WING MEMORIAL HOSPITAL & MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLICON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-284-5302
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-283-7651
Practice Address - Fax:413-284-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALG0028OtherBLUECROSS/BLUESHIELD OF MASSACHUSETTS
MA1001191; 1202057Medicaid
MA1001191; 1202057Medicaid