Basic Information
| Provider Information | |||||||||
| NPI: | 1346218294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON MEDICAL CENTER CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL | ||||||||
| Address2: | 88 E NEWTON STREET, PERKIN ELMER BUILDING RM 111 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174141609 | ||||||||
| FaxNumber: | 6176387545 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 EAST NEWTON STREET | ||||||||
| Address2: | BOSTON MEDICAL CENTER PLACEPERKIN ELMER BUILDING RM 111 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | SILVERIA | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VICE PRESIDENT FOR FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6174142697 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | V112 | MA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1211803 | 05 | MA | MEDICAID | 1009796 | 05 | MA | MEDICAID |