1770714388 NPI number — HILLSIDE ASC LLC

Table of content: (NPI 1770714388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770714388 NPI number — HILLSIDE ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLSIDE ASC 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:
HILLSIDE SURGERY CENTER
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:
1770714388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678
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:
03247-0678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-524-3211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 MAPLE ST
Provider Second Line Business Practice Location Address:
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:
603-527-7514
Provider Business Practice Location Address Fax Number:
603-524-7548
Provider Enumeration Date:
07/30/2009

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: 261QA1903X , with the licence number:  2824 , 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: 30627655 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".