Provider Demographics
NPI:1053644773
Name:FEDERAL BUREAU OF PRISONS
Entity Type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS
Other - Org Name:FEDERAL MEDICAL CENTER DEVENS
Other - Org Type:Other Name
Authorized Official - Title/Position:ACTING CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-796-1411
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-0880
Mailing Address - Country:US
Mailing Address - Phone:978-796-1411
Mailing Address - Fax:978-796-1097
Practice Address - Street 1:42 PATTON RD
Practice Address - Street 2:
Practice Address - City:DEVENS
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-796-1411
Practice Address - Fax:978-796-1097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center