Provider Demographics
NPI: | 1740238526 |
---|---|
Name: | ATRIUS HEALTH, INC. |
Entity Type: | Organization |
Organization Name: | ATRIUS HEALTH, INC. |
Other - Org Name: | HARVARD VANGUARD MEDICAL ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STRONGWATER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 617-559-8042 |
Mailing Address - Street 1: | 275 GROVE ST |
Mailing Address - Street 2: | SUITE 3-300, PROVIDER ENROLLMENT |
Mailing Address - City: | AUBURNDALE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02466-2272 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-559-8374 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 133 BROOKLINE AVE |
Practice Address - Street 2: | |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02215-3904 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-421-1000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2018-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 9782834 | Medicaid | |
MA | 9782834 | Medicaid |