Provider Demographics
NPI: | 1932411493 |
---|---|
Name: | STEWARD ST. ANNES HOSPITAL CORPORATION |
Entity Type: | Organization |
Organization Name: | STEWARD ST. ANNES HOSPITAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | DOYLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 469-341-8807 |
Mailing Address - Street 1: | 795 MIDDLE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | FALL RIVER |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02721-1733 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-674-5600 |
Mailing Address - Fax: | 617-562-7241 |
Practice Address - Street 1: | 795 MIDDLE ST |
Practice Address - Street 2: | |
Practice Address - City: | FALL RIVER |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02721-1733 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-674-5600 |
Practice Address - Fax: | 617-562-7241 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | STEWARD HEALTH CARE SYSTEM LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2010-07-12 |
Last Update Date: | 2019-07-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | ||
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Single Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Single Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Single Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Single Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Single Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Single Specialty | |
No | 2084S0010X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sports Medicine | Group - Single Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 110087082B | Medicaid | |
220020 | Medicare Oscar/Certification |