MEDICARE: BAY STATE ANESTHESIA

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1336439793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY STATE ANESTHESIA

Provider Business Mailing Address
First Line	:	85 FLAGSHIP DR
Second Line	:	SUITE D
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6160
Country	:	US
Telephone Number	:	978-682-6321
Fax Number	:	978-685-5983

Provider Business Practice Location Address
First Line	:	85 FLAGSHIP DR
Second Line	:	SUITE D
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6160
Country	:	US
Telephone Number	:	978-682-6321
Fax Number	:	978-685-5983

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS JOSEPH BIRMINGHAM
Credential	:
Telephone Number	:	978-682-6321

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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Directions to “BAY STATE ANESTHESIA ” Practice Location

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