Provider Demographics
NPI:1497832646
Name:MARTHA'S VINEYARD HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARTHA'S VINEYARD HOSPITAL, INC.
Other - Org Name:SWING BED PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANEM
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:508-684-4587
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:1 HOSPITAL RD
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557
Mailing Address - Country:US
Mailing Address - Phone:508-693-0410
Mailing Address - Fax:508-696-8516
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-693-0410
Practice Address - Fax:508-696-8516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA'S VINEYARD HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2042282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
22Z300Medicare ID - Type Unspecified