OrganizationMassachusetts General Hospital Oral & Maxillofacial SurgeryGeneral Acute Care HospitalHospitalsPractice Address55 Fruit St, Wang Ambulatory Building Suite 230, Boston, MA 02114-2621(617) 726-8222PECOS EnrollmentBased on the most recent information from CMS, provider Massachusetts General Hospital Oral & Maxillofacial Surgery does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 15 days ago.Profile DetailsProvider ID1144509209Provider TypeOrganizationFull NameMassachusetts General Hospital Oral & Maxillofacial SurgerySubpartNoEnumeration Date8/8/2011Last Updated8/8/2011Contact InformationPractice LocationPractice Address55 Fruit St, Wang Ambulatory Building Suite 230, Boston, MA 02114-2621Phone(617) 726-8222FaxUnlisted FaxMailing LocationMailing Address55 Fruit St, Wang Ambulatory Building Suite 230, Boston, MA 02114-2621PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameKaban, Leonard Bruce (Chief)Phone(617) 726-2740Provider TaxonomiesCodeDescriptionLicenseCode282N00000XPrimaryDescriptionGeneral Acute Care HospitalHospitalsLicenseP-36801MassachusettsCode261QS0112XDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID110008955/BDescriptionMedicaidIssuerUnlistedMassachusetts