Organization
FACULTY PRACTICE FOUNDATION , EVANS MEDICAL FOUNDATION
Active
Parent organization
EVANS MEDICAL FOUNDATION
Other names
The Endoscopy Center of Brookline
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVANS MEDICAL FOUNDATION
Authorized official
MRS. ANNMARIE CLOONAN (DIRECTOR)
(617) 638-7231
Entity
Organization
Contact information
Practice address
930 COMMONWEALTH AVE, BOSTON, MA 02215-1274
(617) 414-6600
(617) 414-6601
Mailing address
930 COMMONWEALTH AVE, BOSTON, MA 02215-1274
(617) 414-6600
(617) 414-6601
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035384
NHP
MA
01
—
1320705
CIGNA
MA
01
—
3700270
AETNA
MA
01
—
5624667
FIRST HEALTH
MA
01
—
623859
TUFTS HEALTH PLAN
MA
01
—
M88035
BLUE CROSS BLUE SHIELD
MA
Enumeration date
03/08/2007
Last updated
06/15/2011
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