Provider Demographics
NPI:1720390289
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:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-419-4700
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:2010-07-12
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087064EMedicaid
MA110087064AMedicaid
MA110087064GMedicaid
MA110087064AMedicaid