=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841450152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDITH NOURSE ROGERS MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 07/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SPRINGS RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01730-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-983-2351
-----------------------------------------------------
Fax | 781-687-3179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SPRINGS RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01730-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-983-2351
-----------------------------------------------------
Fax | 781-687-3179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MS. THERESA A MITTON
-----------------------------------------------------
Credential | MSW LCSW
-----------------------------------------------------
Telephone | 781-983-2351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 286500000X
-----------------------------------------------------
Taxonomy Name | Military Hospital
-----------------------------------------------------
License Number | 214754
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------