1770750226 NPI number — BAYSTATE MEDICAL PRACTICE, INC

Table of content: (NPI 1770750226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770750226 NPI number — BAYSTATE MEDICAL PRACTICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYSTATE MEDICAL PRACTICE, 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:
BAYSTATE/BMP ART/IVF
Provider Other Organization Name Type Code:
3
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:
1770750226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 CHESTNUT ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01199-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-794-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
759 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01199-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-794-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CREMONTI
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR MEDICAL STAFF SERVICES
Authorized Official Telephone Number:
413-794-5508

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M16667 . This is a "BC BS GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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