Provider Demographics
NPI:1548202641
Name:BETH ISRAEL DEACONESS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BETH ISRAEL DEACONESS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-667-1961
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:ST 207
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-1961
Mailing Address - Fax:617-975-5700
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:ST 207
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-1961
Practice Address - Fax:617-975-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA220086Medicare Oscar/Certification