1467743427 NPI number — LRGHEALTHCARE

Table of content: (NPI 1467743427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467743427 NPI number — LRGHEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LRGHEALTHCARE
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:
ADVANCED ORTHOPAEDIC SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1467743427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03247-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-524-3211
Provider Business Mailing Address Fax Number:
603-527-7038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GILFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03249-6580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-9011
Provider Business Practice Location Address Fax Number:
603-527-5743
Provider Enumeration Date:
04/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LIPMAN
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EVP-CFO
Authorized Official Telephone Number:
603-527-2802

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  8510 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 332M , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30218923 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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