Healthcare Provider Details

I. General information

NPI: 1841450152
Provider Name (Legal Business Name): EDITH NOURSE ROGERS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-983-2351
  • Fax: 781-687-3179
Mailing address:
  • Phone: 781-983-2351
  • Fax: 781-687-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number214754
License Number StateMA

VIII. Authorized Official

Name: MS. THERESA A MITTON
Title or Position: SOCIAL WORKER
Credential: MSW LCSW
Phone: 781-983-2351