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STEWARD ST ELIZABETHS MEDICAL CENTER OF BOSTON INC

Managed Care Organization Pharmacy

Brighton, Massachusetts

Provider NPI: 1053626283

Organization Information:
Organization Name:  STEWARD ST ELIZABETHS MEDICAL CENTER OF BOSTON INC


Practice Location:
77 WARREN ST PHCY DEPT BRIGHTON, MA 02135 US
Tel: 617-562-5304  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N333600000XSuppliers
Pharmacy
N3336M0003XSuppliers
Pharmacy
Y3336M0002XSuppliers
Pharmacy
MAMA0058873

Other Provider Identifiers:

IssuerNumberStateType
110087064CMA05
PK212807001
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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