Provider Demographics
NPI:1972936623
Name:BAYSTATE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BAYSTATE MEDICAL CENTER, INC.
Other - Org Name:BAYSTATE SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-794-2770
Mailing Address - Street 1:759 CHESTNUT ST
Mailing Address - Street 2:BAYSTATE MEDICAL CENTER, INC ATTN SPECIALTY PHARMACY
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-0001
Mailing Address - Country:US
Mailing Address - Phone:413-794-0000
Mailing Address - Fax:413-794-8087
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:855-865-5432
Practice Address - Fax:413-455-2985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYSTATE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-16
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1427100009Medicare NSC