Healthcare Provider Details

I. General information

NPI: 1053644773
Provider Name (Legal Business Name): FEDERAL BUREAU OF PRISONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PATTON RD
DEVENS MA
01432
US

IV. Provider business mailing address

PO BOX 880
AYER MA
01432-0880
US

V. Phone/Fax

Practice location:
  • Phone: 978-796-1411
  • Fax: 978-796-1097
Mailing address:
  • Phone: 978-796-1411
  • Fax: 978-796-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA RUZE
Title or Position: ACTING CLINICAL DIRECTOR
Credential: MD
Phone: 978-796-1411