=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366515280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILTON HOSPITAL TCU UNIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 10/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 92 HIGHLAND ST
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02186-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-696-4600
-----------------------------------------------------
Fax | 617-313-1567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 HIGHLAND ST
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02186-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-696-4600
-----------------------------------------------------
Fax | 617-313-1567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PATIENT FINANCIAL SERVICES
-----------------------------------------------------
Name | GAIL SCHROTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-313-1214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------