Provider Demographics
NPI:1386718823
Name:BOSTON MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:T
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-414-2693
Mailing Address - Street 1:4199 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1733
Mailing Address - Country:US
Mailing Address - Phone:617-323-4440
Mailing Address - Fax:617-323-7870
Practice Address - Street 1:4199 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1733
Practice Address - Country:US
Practice Address - Phone:617-323-4440
Practice Address - Fax:617-323-7870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV112261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1212095Medicaid
MA1212095Medicaid
MAM20579Medicare ID - Type UnspecifiedPART B