Provider Demographics
NPI:1649217555
Name:BAYSTATE HEALTH SYSTEM AMBULANCE, INC
Entity Type:Organization
Organization Name:BAYSTATE HEALTH SYSTEM AMBULANCE, INC
Other - Org Name:BAYSTATE HEALTH AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-774-3051
Mailing Address - Street 1:PO BOX 3799
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-3799
Mailing Address - Country:US
Mailing Address - Phone:413-773-4500
Mailing Address - Fax:413-773-4584
Practice Address - Street 1:338 HIGH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2611
Practice Address - Country:US
Practice Address - Phone:413-773-4500
Practice Address - Fax:413-773-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA091159OtherCIGNA BEHAVIORAL HEALTH
MA1714082Medicaid
MA702152OtherHARVARD PILGRAM HP
MA091159OtherCONNECTICARE
MA33OtherHAMPSHIRE CNTY HSE OF COR
MA1005380OtherBEACON HEALTH STRATEGIES
MA1005380OtherBMC HEALTHNET PLAN
MA801640OtherTUFTS
MA9207234OtherCIGNA
MA99606601OtherNETWORK HEALTH
MA0009940OtherNEIGHBORHOOD HP
MA091159OtherBC/BS OF MASS
VT1000228OtherVERMONT MEDICAID
MA1005380OtherBEACON HEALTH STRATEGIES