Provider Demographics
NPI:1366544496
Name:BOSTON CENTER FOR AMBULATORY SURGERY INC
Entity type:Organization
Organization Name:BOSTON CENTER FOR AMBULATORY SURGERY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-535-6043
Mailing Address - Street 1:170 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-267-0710
Mailing Address - Fax:617-236-8704
Practice Address - Street 1:170 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-267-0710
Practice Address - Fax:617-236-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2210002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOM77001OtherBLUE CROSS BLUE SHIELD
BOM77001OtherBLUE CROSS BLUE SHIELD
MA221000Medicare PIN