Basic Information
| Provider Information | |||||||||
| NPI: | 1790717650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIGHAM & WOMENS HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 399 REVOLUTION DRIVE | ||||||||
| Address2: | SUITE 535 | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572820363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177325500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | LARSSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR-CBO | ||||||||
| AuthorizedOfficialTelephone: | 8572820363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1202715 | 05 | MA | MEDICAID | 900058 | 01 | MA | HPHC | OTHER | 0002928 | 01 | MA | NHP BIMA | OTHER | 1002562 | 05 | MA | MEDICAID | 2222011001 | 01 | MA | BCBS IP | OTHER | 0006764 | 01 | MA | SJP HEALTHCENTER | OTHER | 903115 | 01 | MA | TAHP IP | OTHER | 0006807 | 01 | MA | NHP SPANISH CLINIC | OTHER | 0006763 | 01 | MA | NHPBROOKSIDE HEALTHCENTER | OTHER | 2222011010 | 01 | MA | BCBS OP | OTHER | 2222011015 | 01 | MA | BCBS OP PSYCH | OTHER | 900054 | 01 | MA | TAHP OP | OTHER | 0007049 | 01 | MA | NHP IP/OP | OTHER | 1201514 | 05 | MA | MEDICAID | 1202693 | 05 | MA | MEDICAID | 2222011012 | 01 | MA | BCBS BROOKSIDE HEALTHCENT | OTHER | 2222011013 | 01 | MA | BCBS SJP HEALTHCENTER | OTHER | 2222011031 | 01 | MA | BCBS SDC | OTHER |