MEDICARE: BAYSTATE MEDICAL CENTER INC

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	3336H0001X	Home Infusion Therapy Pharmacy	3300	MA
2	332B00000X	Durable Medical Equipment & Medical Supplies	3300	MA
3	332BX2000X	Oxygen Equipment & Supplies (DME)	3300	MA

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	:	1295736098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSTATE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	211 CARANDO DR
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-3213
Country	:	US
Telephone Number	:	413-794-4663
Fax Number	:	413-794-5599

Provider Business Practice Location Address
First Line	:	211 CARANDO DR
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-3213
Country	:	US
Telephone Number	:	413-794-4663
Fax Number	:	413-794-5599

Authorized Official
Title or Position	:	SR VP, CFO & TREAS, BAYSTATE HEALTH
Name	:	MR. DENNIS W CHALKE
Credential	:
Telephone Number	:	413-794-3290

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	01/13/2017

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Directions to “BAYSTATE MEDICAL CENTER INC ” Practice Location

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