Provider Demographics
NPI:1174569339
Name:BOSTON MEDICAL CENTER
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VISE PRESIDENT FOR FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-7402
Mailing Address - Street 1:88 E NEWTON STREET
Mailing Address - Street 2:PERKIN ELMER BUILDING, ROOM 111 ATTN: VIRGINIA MUI
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2658
Mailing Address - Country:US
Mailing Address - Phone:617-414-1609
Mailing Address - Fax:617-638-7545
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-638-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV112273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1211803Medicaid
MA1009796Medicaid
MA1211803Medicaid