Healthcare Provider Details

I. General information

NPI: 1558310474
Provider Name (Legal Business Name): BAYSTATE MRI & IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASON AVE.
SPRINGFIELD MA
01107-1119
US

IV. Provider business mailing address

700 CONGRESS ST STE 204
QUINCY MA
02169-0928
US

V. Phone/Fax

Practice location:
  • Phone: 413-730-9200
  • Fax: 508-897-3824
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number4JKJ
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN DELMORE
Title or Position: CFO
Credential:
Phone: 617-376-7400