Healthcare Provider Details

I. General information

NPI: 1134067242
Provider Name (Legal Business Name): BAYSTATE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBRAHAM RD
SPRINGFIELD MA
01109-3161
US

IV. Provider business mailing address

11 WILBRAHAM RD
SPRINGFIELD MA
01109-3161
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURIE E MARTIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 413-794-2578