1902996028 NPI number — ELLIOT HOSPITAL OF THE CITY OF MANCHESTER

Table of content: (NPI 1902996028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902996028 NPI number — ELLIOT HOSPITAL OF THE CITY OF MANCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
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:
1902996028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2040
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03105-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-663-2431
Provider Business Mailing Address Fax Number:
603-663-5820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ELLIOT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-2431
Provider Business Practice Location Address Fax Number:
603-663-5820
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CULLEROT
Authorized Official First Name:
MARC
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
603-663-8977

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  00018 , 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: 300012 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 80300012 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H000556 . This is a "TRICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 900122 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: OTHER . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 904223 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com