Basic Information
| Provider Information | |||||||||
| NPI: | 1376827188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECTRUM HEALTH SYSTEMS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MECHANIC ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016082420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087925400 | ||||||||
| FaxNumber: | 5088310058 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 MERRICK ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016091937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087976100 | ||||||||
| FaxNumber: | 5087970693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2011 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | LANGLOIS | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5087925400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 2220002001 | 01 | MA | BLUE CROSS BLUE SHEILD | OTHER | M18684 | 01 | MA | BLUE CROSS BLUE SHEILD | OTHER | 1308785 | 05 | MA | MEDICAID | 1306421 | 05 | MA | MEDICAID |