Provider Demographics
NPI:1669848701
Name:IBEAM MEDICAL MASSACHUSETTS
Entity type:Organization
Organization Name:IBEAM MEDICAL MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-214-4656
Mailing Address - Street 1:1085 COMMONWEALTH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1002
Mailing Address - Country:US
Mailing Address - Phone:866-214-4656
Mailing Address - Fax:
Practice Address - Street 1:1085 COMMONWEALTH AVE STE 302
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1002
Practice Address - Country:US
Practice Address - Phone:866-214-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies