Provider Demographics
NPI:1922301779
Name:BAYSTATE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BAYSTATE MEDICAL CENTER, INC.
Other - Org Name:BAYSTATE HOME INFUSION & RESPIRATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, CFO & TREAS, BAYSTATE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-794-3290
Mailing Address - Street 1:211 CARANDO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3213
Mailing Address - Country:US
Mailing Address - Phone:413-794-4663
Mailing Address - Fax:413-794-5599
Practice Address - Street 1:85 SOUTH ST
Practice Address - Street 2:ROOM D101
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1625
Practice Address - Country:US
Practice Address - Phone:413-967-2855
Practice Address - Fax:413-967-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020829YMedicaid
MA1427100008Medicare NSC