Provider Demographics
NPI:1588863179
Name:MOUNT AUBURN HOSPITAL
Entity type:Organization
Organization Name:MOUNT AUBURN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-245-6238
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:OCCUPATIONAL HEALTH 5TH FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-354-0546
Mailing Address - Fax:617-868-0497
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:OCCUPATIONAL HEALTH 5TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-354-0546
Practice Address - Fax:617-868-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162473261Q00000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center