Provider Demographics
NPI:1649254491
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 1:330 MOUNT AUBURN ST
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:617-499-5422
Practice Address - Street 1:330 MOUNT AUBURN ST
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:617-499-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2898273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA50-40078OtherUNITED HEALTHCARE
MA996324OtherNETWORK HEALTH PLAN
MA0007057OtherNEIGHBORHOOD HEALTH PLAN
MA1002150OtherBEACON HEALTH-OUTPATIENT
MA0012149OtherAETNA/US HEALTHCARE
MA245718OtherMAGELLAN/MA MERIT CLAIMS
MAMOU2222000230OtherBLUE X MASTER MEDICAL
MA900037OtherTUFTS ASSC HLTH PL. INPAT
MA900749OtherTUFTS ASSC HLTH PL-OUTPAT
MA900749OtherTUFTS ASSC HLTH PL-OUTPAT
MAMOU2222000230OtherBLUE X MASTER MEDICAL
MA50-40078OtherUNITED HEALTHCARE