MEDICARE: BOSTON MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255624250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4199 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:	617-323-4440
Fax Number	:	617-323-7870

Provider Business Practice Location Address
First Line	:	4199 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:	617-323-4440
Fax Number	:	617-323-7870

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA J. LOTTERO
Credential	:
Telephone Number	:	617-363-1200

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	05/24/2011

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Directions to “BOSTON MEDICAL CENTER ” Practice Location

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