1760555064 NPI number — UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION

Table of content: (NPI 1760555064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760555064 NPI number — UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION
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:
1760555064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 CORLISS LANE
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
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 LANE
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
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:
11/16/2006

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:
603-237-4971

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)

  • Identifier: 301300 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "0049127" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301300 . This is a "VTW" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 5129902 . This is a "VMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138560000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80300033 . This is a "NHW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 926356 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0059200 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0301300 . This is a "CAH ACUTE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 301300 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80300033 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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