Organization
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON M RADZEVICH (V.P. OF FINANCE AND CFO)
(508) 830-2005
Entity
Organization
Contact information
Practice address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 746-2000
(508) 830-1131
Mailing address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 746-2000
(508) 830-1131
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
2082
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020545
BMC HEALTHNET
MA
05
—
1001434
—
MA
05
—
110024453C
—
MA
01
—
220060
MEDICARE PTAN
MA
01
—
2222006001
BCBS MA INPATIENT
MA
01
—
500444
TUFTS 1500 PSYCH BILLING
MA
01
—
900002
HPHC
MA
01
—
900021
TUFTS INPATIENT
MA
01
—
S012236
CHAMPUS
MA
Enumeration date
01/10/2006
Last updated
03/23/2021
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