Provider Demographics
NPI:1164060778
Name:BID-MILTON PHYSICIAN ASSOCIATES INC
Entity Type:Organization
Organization Name:BID-MILTON PHYSICIAN ASSOCIATES INC
Other - Org Name:BETH ISRAEL LAHEY HEALTH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-615-9562
Mailing Address - Street 1:199 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3926
Mailing Address - Country:US
Mailing Address - Phone:617-615-9562
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER J. HANNON PKWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-615-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care