1063850345 NPI number — UPPER CONNECTICUT VALLEY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063850345 NPI number — UPPER CONNECTICUT VALLEY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER CONNECTICUT VALLEY HOSPITAL
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:
AMBULATORY SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1063850345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 CORLISS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLEBROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03576-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-237-4971
Provider Business Mailing Address Fax Number:
603-237-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 CORLISS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLEBROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03576-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-237-4971
Provider Business Practice Location Address Fax Number:
603-237-4452
Provider Enumeration Date:
06/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FRIZZELL
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
603-388-4242

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  00592 , 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)





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