Basic Information
| Provider Information | |||||||||
| NPI: | 1518173871 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RENAL DIALYSIS SERVICES OF BMC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4999 | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012024999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472000 | ||||||||
| FaxNumber: | 4134472803 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 CONTE DR | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012018298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472000 | ||||||||
| FaxNumber: | 4134472803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/07/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GROMACKI | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROJECT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4134473442 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | VQKK | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 1200143 | 05 | MA | MEDICAID | 10558 | 01 | HEALTH NEW ENGLAND | OTHER | 2222004601 | 01 | MA | BLUE CROSS INPT | OTHER | 900201 | 01 | TUFTS HEALTH PLAN OUTPT | OTHER | 220046 | 01 | HUMANA | OTHER | 220046 | 01 | MA | UNICARE MA EMPLOYEE GIC | OTHER | 2222004630 | 01 | MA | BLUE CROSS SDC | OTHER | 900357 | 01 | HARVARD PILGRIM HEALTH | OTHER | 0160 | 01 | MVP | OTHER | 2222004610 | 01 | MA | BLUE CROSS OUTPT | OTHER | 905652 | 01 | TUFTS HEALTH PLAN INPT | OTHER | 991396 | 01 | CONNECTICARE | OTHER | HO1478 | 01 | OXFORD | OTHER | 260158 | 01 | MAGELLAN BEHAVIORAL HEALT | OTHER | 1099981 | 05 | MA | MEDICAID | 20300 | 01 | MA | BMC HEALTH NET PLAN | OTHER | 6300730 | 01 | AETNA | OTHER | 10005746 | 01 | CDPHP | OTHER |