Healthcare Provider Details

I. General information

NPI: 1245272012
Provider Name (Legal Business Name): BAYSTATE NOBLE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W SILVER ST
WESTFIELD MA
01085-3628
US

IV. Provider business mailing address

115 W SILVER ST
WESTFIELD MA
01085-3628
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-2811
  • Fax: 413-562-5855
Mailing address:
  • Phone: 413-568-2811
  • Fax: 413-562-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2076
License Number StateMA

VIII. Authorized Official

Name: DAVID WITHERELL
Title or Position: SENIOR DIRECTOR, PAYMENT SYSTEMS
Credential:
Phone: 413-794-7930