Provider Demographics
NPI:1922259753
Name:BOSTON HEART DIAGNOSTICS CORPORATION
Entity Type:Organization
Organization Name:BOSTON HEART DIAGNOSTICS CORPORATION
Other - Org Name:BOSTON HEART LAB CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:URBANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-799-1610
Mailing Address - Street 1:200 CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-4486
Mailing Address - Country:US
Mailing Address - Phone:508-877-8711
Mailing Address - Fax:508-877-1002
Practice Address - Street 1:200 CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-4486
Practice Address - Country:US
Practice Address - Phone:508-877-8711
Practice Address - Fax:508-877-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082613BMedicaid