Provider Demographics
NPI:1902168339
Name:MOUNT AUBURN HOSPITAL
Entity Type:Organization
Organization Name:MOUNT AUBURN HOSPITAL
Other - Org Name:MAHDME DIVISION
Other - Org Type:Other Name
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 1:330 MOUNT AUBURN STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-492-3500
Mailing Address - Fax:617-499-5584
Practice Address - Street 1:330 MOUNT AUBURN STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-492-3500
Practice Address - Fax:617-499-5584
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT AUBURN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-12
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2898282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA50-40078OtherUNITED HEALTH CARE
MA900037OtherINPATIENT TUFTS MEDICARE PREFERRED
MA0007057OtherNEIGHBORHOOD HEALTH PLAN
MA1099876Medicaid
MA2222000205OtherPSYCHIATRY BLUE CROSS
MA900023OtherHARVARD PILGRIM HEALTH CARE
MA0012149OtherAETNA
MA1201298Medicaid
MA2222000210OtherOUTPATIENT BLUE CROSS
MA2222000201OtherINPATIENT BLUE CROSS
MA900749OtherOUTPATIENT TUFTS MEDICARE PREFERRED
MA2222000230OtherSURG. DAY CARE BLUE CROSS
MA996324OtherNETWORK HEALTH
MA900749OtherOUTPATIENT TUFTS MEDICARE PREFERRED
MA900037OtherINPATIENT TUFTS MEDICARE PREFERRED
MA2222000230OtherSURG. DAY CARE BLUE CROSS