Provider Demographics
NPI:1245440726
Name:MMDS OF BOSTON LLC
Entity type:Organization
Organization Name:MMDS OF BOSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GRINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:617-244-9729
Mailing Address - Street 1:48 SILVER LAKE AVE.
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1111
Mailing Address - Country:US
Mailing Address - Phone:617-244-9729
Mailing Address - Fax:
Practice Address - Street 1:48 SILVER LAKE AVE.
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1111
Practice Address - Country:US
Practice Address - Phone:617-244-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22X0009830Medicare ID - Type UnspecifiedPORTABLE X-RAY