Provider Demographics
NPI:1770738262
Name:WING MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:WING MEMORIAL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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?:Yes
Parent Organization LBN:WING MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-25
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2222003013OtherBLUE CROSS OUTPT. MEDICAL CENTERS
MA0608149Medicaid
220030OtherMEDICARE
MA2222003010OtherBLUE CROSS - HOSPITAL OUTPATIENT
MA0608157Medicaid
MA1001191Medicaid
MA1202057Medicaid