1568438349 NPI number — ELLIOT PROFESSIONAL SERVICES

Table of content: (NPI 1568438349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568438349 NPI number — ELLIOT PROFESSIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLIOT PROFESSIONAL SERVICES
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:
GREATER AMHERST IMAGING
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:
1568438349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEETING PLACE PLAZA 199 - ROUTE 101
Provider Second Line Business Mailing Address:
GREATER AMHERST IMAGING
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-249-3000
Provider Business Mailing Address Fax Number:
603-249-3021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEETING PLACE PLAZA 199 - ROUTE 101
Provider Second Line Business Practice Location Address:
GREATER AMHERST IMAGING
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-249-3000
Provider Business Practice Location Address Fax Number:
603-249-3021
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
DIRECTOR OF OPERATION & FINANCE
Authorized Official Telephone Number:
603-663-4904

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 626438 . This is a "HPHC GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3206971 . This is a "AETNA GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P00009327 . This is a "RR MEDICARE GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 60146303 . This is a "W/C DOL GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 15Y002259NH02 . This is a "ANTHEM GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 667222 . This is a "CIGNA GRP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30812256 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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