Provider Demographics
NPI:1871941070
Name:ST. ELIZABETH'S MEDICAL CENTERS
Entity type:Organization
Organization Name:ST. ELIZABETH'S MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SORESSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-3000
Mailing Address - Street 1:16 EUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4092
Mailing Address - Country:US
Mailing Address - Phone:857-218-9386
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256860261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center