Provider Demographics
NPI:1669630950
Name:UMASS MEMORIAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:UMASS MEMORIAL MEDICAL CENTER, INC.
Other - Org Name:PRESCRIPTION CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-443-2848
Mailing Address - Street 1:119 BELMONT ST
Mailing Address - Street 2:MEMORIAL CAMPUS
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2903
Mailing Address - Country:US
Mailing Address - Phone:508-421-1990
Mailing Address - Fax:508-334-6100
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:MEMORIAL CAMPUS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-421-1990
Practice Address - Fax:508-334-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA0050106333600000X
MADS89916333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2242319OtherNCPDP
MA110022124OMedicaid
MA220163Medicaid
MA110022124ZMedicaid
6194840003Medicare NSC