Provider Demographics
NPI:1841257938
Name:ENRM VETERANS ADMINISTRATION MEDICAL CENTER
Entity type:Organization
Organization Name:ENRM VETERANS ADMINISTRATION MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WAGHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-687-2201
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:MENTAL HEALTH CLINIC
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-3592
Mailing Address - Fax:781-687-2018
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:MENTAL HEALTH CLINIC
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-3592
Practice Address - Fax:781-687-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163625PC282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPHNS0515Medicare ID - Type UnspecifiedPART B