Provider Demographics
NPI:1477021608
Name:NANTUCKET COTTAGE HOSPITAL
Entity Type:Organization
Organization Name:NANTUCKET COTTAGE HOSPITAL
Other - Org Name:NANTUCKET COTTAGE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING/COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-825-8203
Mailing Address - Street 1:57 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-825-8100
Mailing Address - Fax:
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-825-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTUCKET COTTAGE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-06
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026734DMedicaid