1326051798 NPI number — BAYSTATE MEDICAL CENTER INC.

Table of content: (NPI 1326051798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326051798 NPI number — BAYSTATE MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYSTATE MEDICAL CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1326051798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
489 BERNARDSTON RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-773-2378
Provider Business Practice Location Address Fax Number:
413-773-2386
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110020829Q , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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