NPIMap

Organization Active NPI

St. Elizabeth's Healthcare at Hanscom Air Base

  • Clinic/Center
  • Hanscom AFB, MA
National Provider Identifier
1467524827
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ST. ELIZABETH'S HEALTHCARE AT HANSCOM AIR BASE
Practice address
1609 Eglin St
Hanscom AFB, MA 01731-2613
Phone
(617) 789-2204
Fax
(617) 562-5415
NPI assigned
Nov 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miles Coverdale
Title
Cfo
Phone
(617) 789-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1609 Eglin St
Hanscom AFB, MA 01731-2613

Mailing address

1609 Eglin St
Hanscom AFB, MA 01731-2613
Phone (617) 789-2204

Other identifiers 1

IdentifierTypeStateIssuer
1214225MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Caritas St Elizabeth Medical Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1609 Eglin St
Hanscom AFB, MA 01731
Phone (781) 377-4740

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467524827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 EGLIN ST",
            "city": "HANSCOM AFB",
            "state": "MA",
            "postal_code": "017312613",
            "telephone_number": "617-789-2204",
            "fax_number": "617-562-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 EGLIN ST",
            "city": "HANSCOM AFB",
            "state": "MA",
            "postal_code": "017312613",
            "telephone_number": "617-789-2204",
            "fax_number": "617-562-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH'S HEALTHCARE AT HANSCOM AIR BASE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COVERDALE",
        "authorized_official_first_name": "MILES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "617-789-3000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1214225",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanscom AFB, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.