1922259753 NPI number — BOSTON HEART DIAGNOSTICS CORPORATION

Table of content: (NPI 1922259753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922259753 NPI number — BOSTON HEART DIAGNOSTICS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON HEART DIAGNOSTICS CORPORATION
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:
BOSTON HEART LAB CORPORATION
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:
1922259753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CROSSING BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-4486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-877-8711
Provider Business Mailing Address Fax Number:
508-877-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CROSSING BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-4486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-877-8711
Provider Business Practice Location Address Fax Number:
508-877-1002
Provider Enumeration Date:
10/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
URBANEK
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-799-1610

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110082613B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016544100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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