Provider Demographics
NPI:1942450242
Name:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:HALLMARK HEALTH MEDICAL ASSOCIATES INC
Other - Org Name:HHMA #2-NON-PCHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FISCAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TURILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-338-7415
Mailing Address - Street 1:PO BOX 3237
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC (#2)-NON-PCHI
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-3237
Mailing Address - Country:US
Mailing Address - Phone:781-338-7170
Mailing Address - Fax:781-338-7173
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES INC (#2)-NON-PCHI
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-338-7170
Practice Address - Fax:781-338-7173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALLMARK HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANON-PCHI GROUPOtherBCBS