1033274295 NPI number — THE CANCER CENTER OF BOSTON, INC.

Table of content: (NPI 1033274295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033274295 NPI number — THE CANCER CENTER OF BOSTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CANCER CENTER OF BOSTON, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE CANCER CENTER INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033274295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 BOYLSTON ST
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-735-6605
Provider Business Mailing Address Fax Number:
617-739-4819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
CHESTNUT HILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-735-6605
Provider Business Practice Location Address Fax Number:
617-739-4819
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
ARLETTE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
617-739-6605

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8000 . This is a "CIGNA HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22286 . This is a "FALLON COMM. HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: S015002 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9763147 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0092501 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30004225 . This is a "NEW HAMPSHIRE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 718250 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com