MEDICARE: THE COMMONWEALTH OF MASSACHUSETTS

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	273R00000X	Psychiatric Hospital Unit

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	:	1285759464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMONWEALTH OF MASSACHUSETTS

Provider Business Mailing Address
First Line	:	85 E NEWTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-2340
Country	:	US
Telephone Number	:	617-626-8860
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 E NEWTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-2340
Country	:	US
Telephone Number	:	617-626-8860
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JAMES E COONEY
Credential	:
Telephone Number	:	617-626-8796

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/21/2023

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Directions to “THE COMMONWEALTH OF MASSACHUSETTS ” Practice Location

Language	Start Address	Practice Location

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