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 2 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