Provider Demographics
NPI:1104946862
Name:KLS MANAGEMENT
Entity type:Organization
Organization Name:KLS MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-739-1300
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1930
Mailing Address - Country:US
Mailing Address - Phone:617-739-1300
Mailing Address - Fax:617-739-5967
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1930
Practice Address - Country:US
Practice Address - Phone:617-739-1300
Practice Address - Fax:617-739-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780661Medicaid
MAP00191969OtherRAILROAD MEDICARE
MA5845531OtherAETNA
MA974285OtherNETWORKHEALTH
MA611868OtherTUFTS
MA034469OtherBCBS
MA9780661Medicaid