Provider Demographics
NPI:1568880110
Name:BETH ISRAEL DEACONESS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BETH ISRAEL DEACONESS MEDICAL CENTER, INC
Other - Org Name:BETH ISRAEL DEACONESS URGENT CARE CENTER AT CHESTNUT HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
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:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-7000
Mailing Address - Fax:617-975-5700
Practice Address - Street 1:200 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2012
Practice Address - Country:US
Practice Address - Phone:617-667-7000
Practice Address - Fax:617-975-5700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL DEACONESS MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-01
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
220086Medicare PIN