Provider Demographics
NPI:1346218294
Name:BOSTON MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-6903
Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:88 E NEWTON STREET, PERKIN ELMER BUILDING RM 111
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
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 2:88 E NEWTON STREET, PERKIN ELMER BUILDING RM 111
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-1609
Practice Address - Fax:617-638-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV112282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1211803Medicaid
MA1009796Medicaid
MA220031Medicare Oscar/Certification