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General NPI Number Information
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NPI Number | 1003607193
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Entity Type | Organization
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Legal Business Name | BLUE CROSS BLUE SHIELD OF MASSACHUSETTS
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 101 HUNTINGTON AVE STE 1300
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City | BOSTON
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State | MA
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Zip | 02199-7611
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Country | US
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Telephone | 617-246-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 53 WOODBINE RD
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City | STOUGHTON
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State | MA
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Zip | 02072-1772
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL POLICY SPECIALIST
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Name | JOANNA FARRELL
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Credential | RN
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Telephone | 617-470-2541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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