Healthcare Provider Details

I. General information

NPI: 1174569339
Provider Name (Legal Business Name): BOSTON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

88 E NEWTON STREET PERKIN ELMER BUILDING, ROOM 111 ATTN: VIRGINIA MUI
BOSTON MA
02118-2658
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8000
  • Fax:
Mailing address:
  • Phone: 617-414-1609
  • Fax: 617-638-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberV112
License Number StateMA

VIII. Authorized Official

Name: MR. RONALD E BARTLETT
Title or Position: CFO/VISE PRESIDENT FOR FINANCE
Credential:
Phone: 617-638-7402