Healthcare Provider Details

I. General information

NPI: 1881929990
Provider Name (Legal Business Name): EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD #180
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD #180
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-983-9170
  • Fax: 781-687-2228
Mailing address:
  • Phone: 781-983-9170
  • Fax: 781-687-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number1031246
License Number StateMA

VIII. Authorized Official

Name: DR. ANDREW BUDSON
Title or Position: ACTING CHIEF OF STAFF
Credential: MD
Phone: 781-687-2203