Provider Demographics
NPI:1316022064
Name:COMMONWEALTH HEALTH SYSTEMS INC.
Entity Type:Organization
Organization Name:COMMONWEALTH HEALTH SYSTEMS INC.
Other - Org Name:GODDARD BROCKTON KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHREEKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-341-8550
Mailing Address - Street 1:53 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2436
Mailing Address - Country:US
Mailing Address - Phone:781-341-8550
Mailing Address - Fax:781-341-8768
Practice Address - Street 1:907 SUMNER ST
Practice Address - Street 2:SUITE M107
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3374
Practice Address - Country:US
Practice Address - Phone:781-341-8550
Practice Address - Fax:781-341-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309536Medicaid
MA730145OtherTUFTS
MA222222310OtherBLUE CROSS BLUE SHIELD
MA626151OtherHARVARD PILGRIM HEALTH
MA626151OtherHARVARD PILGRIM HEALTH
MA1309536Medicaid