Provider Demographics
NPI:1316917941
Name:NORTHEAST HOSPITAL CORPORATION
Entity type:Organization
Organization Name:NORTHEAST HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3000
Mailing Address - Street 1:85 HERRICK ST
Mailing Address - Street 2:BEVERLY HOSPITAL
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1776
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:978-921-7071
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:BEVERLY HOSPITAL
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1776
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:978-921-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV93D273R00000X
MA15282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000039Medicaid
MA2222003301OtherBC HMO/PHO INPAT
MA901790OtherTUFTS PHO INPAT
MA9343OtherAETNA HMO
MABEV2222003301OtherHMO BLUE INPAT
MAS005394OtherCHAMPUS
MA2222003311OtherBC HMO/PHO OUTPAT
MA901790OtherTUFTS MCR INPAT
MA0007079Medicaid
MA2222003301OtherBC INDEM INPAT
MA900385OtherFIRST SENIORITY
MA1202626Medicaid
MA2222003311OtherBC INDEM OUTPAT
MA900082OtherTUFTS MCR OUTPAT
MD1000039Medicaid
MA900082OtherTUFTS PHO OUTPAT
MA900385OtherHARVARD PILGRIM HMO
MABEV2222003311OtherHMO BLUE OUTPAT
MA0007079Medicaid