Healthcare Provider Details

I. General information

NPI: 1043299001
Provider Name (Legal Business Name): BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-2000
  • Fax: 508-830-1131
Mailing address:
  • Phone: 508-746-2000
  • Fax: 508-830-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2082
License Number StateMA

VIII. Authorized Official

Name: JASON M RADZEVICH
Title or Position: V.P. OF FINANCE AND CFO
Credential:
Phone: 508-830-2005