Provider Demographics
NPI:1962410233
Name:BAYSTATE WING HOSPITAL CORPORATION
Entity type:Organization
Organization Name:BAYSTATE WING HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP, CFO & TREASURER, BH
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-794-3290
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-283-7651
Practice Address - Fax:413-284-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2181282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1001191Medicaid
903286OtherTUFTS - OUTPATIENT
MA2222003085OtherBCBS BEHAVIORAL HLTH
MA1202057Medicaid
MA2222003010OtherBCBS HOSPITAL OUTPT.
MA2222003013OtherBCBS MEDICAL CENTERS (OV)
797489OtherNETWORK HEALTH
MA2222003001OtherBCBS HOSPITAL INPT.
MA2222003030OtherBCBS OBSERVATION/SDC
903078OtherHARVARD PILGRIM/HOSPITAL
903285OtherTUFTS - HOSPITAL I/P
MA2222003010OtherBCBS HOSPITAL OUTPT.