Provider Demographics
NPI:1861823783
Name:BLUE HILL PAIN CARE PLLC
Entity Type:Organization
Organization Name:BLUE HILL PAIN CARE PLLC
Other - Org Name:BHPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-817-5383
Mailing Address - Street 1:639 GRANITE ST STE 215
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5371
Mailing Address - Country:US
Mailing Address - Phone:781-817-5383
Mailing Address - Fax:781-817-6177
Practice Address - Street 1:639 GRANITE ST STE 215
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5371
Practice Address - Country:US
Practice Address - Phone:781-817-5383
Practice Address - Fax:781-817-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51193208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001253Medicaid