Provider Demographics
NPI:1659241560
Name:ATHOL MEMORIAL HOSPITAL INCORPORATED
Entity type:Organization
Organization Name:ATHOL MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-450-6027
Mailing Address - Street 1:242 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2033 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-3535
Practice Address - Country:US
Practice Address - Phone:978-249-3511
Practice Address - Fax:978-249-2651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHOL MEMORIAL HOSPITAL INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024479BMedicaid