Basic Information
Provider Information | |||||||||
NPI: | 1659436996 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 725 NORTH ST | ||||||||
Address2: |   | ||||||||
City: | PITTSFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 012014109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4134472000 | ||||||||
FaxNumber: | 4134472803 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/27/2006 | ||||||||
LastUpdateDate: | 03/19/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RODOWICZ | ||||||||
AuthorizedOfficialFirstName: | DARLENE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 4134472000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BERKSHIRE MEDICAL CENTER, INC. | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | VQKK | MA | Y |   | Hospital Units | Psychiatric Unit |   |
ID Information
ID | Type | State | Issuer | Description | 10558 | 01 |   | HEALTH NEW ENGLAND | OTHER | 20300 | 01 | MA | BMC HEALTH NET PLAN | OTHER | 220046 | 01 |   | HUMANA | OTHER | 0160 | 01 |   | MVP HEALTH PLAN | OTHER | 1200143 | 05 | MA |   | MEDICAID | 220046 | 01 | MA | UNICARE MA EMPLOYEE GIC | OTHER | 10005746 | 01 |   | CDPHP | OTHER | 260158 | 01 |   | MAGELLAN BEHAVIORAL HEALT | OTHER | 6300730 | 01 |   | AETNA | OTHER | 2222004601 | 01 | MA | BLUE CROSS INPT | OTHER | 2222004630 | 01 | MA | BLUE CROSS SDC | OTHER | 900357 | 01 |   | HARVARD PILGRIM HEALTH | OTHER | 1099981 | 05 | MA |   | MEDICAID | 2222004610 | 01 | MA | BLUE CROSS OUTPT | OTHER | 900201 | 01 |   | TUFTS HEALTH PLAN OUTPT | OTHER | 905652 | 01 |   | TUFTS HEALTH PLAN INPT | OTHER | 991396 | 01 |   | CONNECTICARE | OTHER | HO1478 | 01 |   | OXFORD | OTHER |