Provider Demographics
NPI:1932313228
Name:CAMBRIDGE PUBLIC HEALTH COMMISSION
Entity Type:Organization
Organization Name:CAMBRIDGE PUBLIC HEALTH COMMISSION
Other - Org Name:CAMBRIDGE HEALTH ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM DIRECTOR MEDICAL STAFF SRV.
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-665-1616
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:617-665-1000
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:PROVIDER ENROLLMENT
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAVVA5282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779043Medicaid
MA9779159Medicaid
613900OtherTUFTS PAYEE NUMBER
MAM15404OtherBCBS GROUP NUMBER
MAM18077OtherBCBS GROUP NUMBER
MAM21699Medicare PIN