Provider Demographics
NPI:1457664138
Name:STEWARD ST. ELIZABETH'S MEDICAL CENTER OF BOSTON, INC.
Entity Type:Organization
Organization Name:STEWARD ST. ELIZABETH'S MEDICAL CENTER OF BOSTON, INC.
Other - Org Name:ST. ELIZABETH'S RENAL DIALYSIS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-2706
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-3000
Mailing Address - Fax:617-562-7241
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:617-562-7241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWARD HEALTH CARE SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment