Provider Demographics
NPI:1902880016
Name:MOUNT AUBURN HOSPITAL
Entity Type:Organization
Organization Name:MOUNT AUBURN HOSPITAL
Other - Org Name:MOUNT AUBURN HOME CARE
Other - Org Type:Doing Business As
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 1:1 ARSENAL MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5018
Mailing Address - Country:US
Mailing Address - Phone:617-673-1700
Mailing Address - Fax:
Practice Address - Street 1:1 ARSENAL MARKET PL
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5018
Practice Address - Country:US
Practice Address - Phone:617-673-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2898251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702015OtherHPHC PROVIDER #
MA803064OtherTUFTS / SECURE PROVIDER #
MA0607436Medicaid
MA120023OtherBX PROVIDER #
MA702015OtherHPHC PROVIDER #