Healthcare Provider Details

I. General information

NPI: 1881799427
Provider Name (Legal Business Name): BAYSTATE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HIGH ST
SPRINGFIELD MA
01105-1442
US

IV. Provider business mailing address

140 HIGH ST
SPRINGFIELD MA
01105-1442
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9960
  • Fax: 413-794-9959
Mailing address:
  • Phone: 413-794-9960
  • Fax: 413-794-9959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberMA0052124
License Number StateMA

VIII. Authorized Official

Name: LAURIE MARTIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 413-794-9960