Healthcare Provider Details

I. General information

NPI: 1669816880
Provider Name (Legal Business Name): CHS MASSACHUSETTS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OTIS ST ASTRAZENECA
WESTBOROUGH MA
01581-3323
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 400
BRENTWOOD TN
37027-4948
US

V. Phone/Fax

Practice location:
  • Phone: 508-836-8318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: STUART CLARK
Title or Position: EXECUTIVE VP
Credential:
Phone: 615-577-4927