Organization
PROFESSIONAL OUTPATIENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN HANSCOM (CFO)
(617) 636-5000
Entity
Organization
Contact information
Practice address
750 WASHINGTON ST, BOSTON, MA 02111-1526
(617) 636-5000
Mailing address
750 WASHINGTON ST, BOSTON, MA 02111-1526
(617) 636-5000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001329
—
MA
01
—
220116
MEDICARE
MA
Enumeration date
07/27/2007
Last updated
09/14/2020
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