1821046061 NPI number — MERRIMACK VALLEY ORTHOPAEDIC SURGERY

Table of content: (NPI 1821046061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821046061 NPI number — MERRIMACK VALLEY ORTHOPAEDIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRIMACK VALLEY ORTHOPAEDIC SURGERY
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:
1821046061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 ELLIOT WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103-3547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-625-1655
Provider Business Mailing Address Fax Number:
603-626-4686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 ELLIOT WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-625-1655
Provider Business Practice Location Address Fax Number:
603-626-4686
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVIER
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
603-668-4253

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  8097 , 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: 708165 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: NAS928 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0066136 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0103992Y0NH01 . This is a "ANTHEM" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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