Provider Demographics
NPI:1881801868
Name:SAINT ELIZABETH MEDICAL CENTER DIALYSIS UNIT
Entity type:Organization
Organization Name:SAINT ELIZABETH MEDICAL CENTER DIALYSIS UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OSLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-664-3884
Mailing Address - Street 1:PO BOX 50664
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01815-0001
Mailing Address - Country:US
Mailing Address - Phone:800-664-3884
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:800-664-3884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1201719Medicaid
MA222303Medicare ID - Type Unspecified