Provider Demographics
NPI:1710100672
Name:TUFTS UNIVERSITY
Entity Type:Organization
Organization Name:TUFTS UNIVERSITY
Other - Org Name:CLINICAL AFFARIS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-636-6842
Mailing Address - Street 1:1 KNEELAND ST
Mailing Address - Street 2:CLINIC BUSINESS OFFICE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1527
Mailing Address - Country:US
Mailing Address - Phone:617-636-3746
Mailing Address - Fax:617-636-6994
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:CLINIC BUSINESS OFFICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-3746
Practice Address - Fax:617-636-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4105261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0241695Medicaid
MA0241822Medicaid