Basic Information
| Provider Information | |||||||||
| NPI: | 1528328861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | PO BOX 4999 | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472000 | ||||||||
| FaxNumber: | 4134472803 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138549910 | ||||||||
| FaxNumber: | 4138549911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 06/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | RODOWICZ | ||||||||
| AuthorizedOfficialFirstName: | DARLENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4134472000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | 0160 | 01 | MA | MVP | OTHER | H01478 | 01 | MA | OXFORD | OTHER | 10558 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 1200143 | 05 | MA | MEDICAID | 905652 | 01 | MA | TUFTS INPATIENT | OTHER | 000000020300 | 01 | MA | BMC HEALTH NET PLAN | OTHER | 10005746 | 01 | MA | CDPHP IN PATIENT | OTHER | 2222004630 | 01 | MA | BLUE CROSS SDC | OTHER | 900201 | 01 | MA | TUFTS OUTPATIENT | OTHER | 900357 | 01 | MA | HARVARD PILGRIM | OTHER | 220046 | 01 | MA | UNICARE MA EMPLOYEE GIC | OTHER | 10005746 | 01 | MA | CDPHP OUT PATIENT | OTHER | 2222004610 | 01 | MA | BLUE CROSS OUT PATIENT | OTHER | 991396 | 01 | MA | CONNECTICARE | OTHER | 2222004601 | 01 | MA | BLUE CROSS INPATIENT | OTHER | 1099981 | 05 | MD | MEDICAID | 6300730 | 01 | MA | AETNA | OTHER |