1417993494 NPI number — CONCORD AMBULATORY SURGERY CENTER, LLC

Table of content: (NPI 1417993494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417993494 NPI number — CONCORD AMBULATORY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORD AMBULATORY SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417993494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 COMMERCIAL ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-415-9460
Provider Business Mailing Address Fax Number:
603-415-9465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-5071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-415-9460
Provider Business Practice Location Address Fax Number:
603-415-9465
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL OF CORPORATION
Authorized Official Telephone Number:
603-227-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  03034 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18Y007689NH01 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 73992 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 002489615001 . This is a "UNITED HEALTHCARE PROVIDE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2241466 . This is a "FIRST HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7170718 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30623452 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00066359 . This is a "MARTINS POINT PROVIDER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 904456 . This is a "HARVARD PILGRIM PROVIDER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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