Healthcare Provider Details

I. General information

NPI: 1972936623
Provider Name (Legal Business Name): BAYSTATE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

759 CHESTNUT ST BAYSTATE MEDICAL CENTER, INC ATTN SPECIALTY PHARMACY
SPRINGFIELD MA
01199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 855-865-5432
  • Fax: 413-455-2985
Mailing address:
  • Phone: 413-794-0000
  • Fax: 413-794-8087

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 MARTIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 855-865-5432