Provider Demographics
NPI:1053642892
Name:ELLIOT PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:ELLIOT FAMILY MEDICINE AT MANCHESTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:4 ELLIOT WAY, SUITE 100
Mailing Address - Street 2:ELLIOT FAMILY MEDICINE AT MANCHESTER
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3551
Mailing Address - Country:US
Mailing Address - Phone:603-626-5113
Mailing Address - Fax:603-622-5298
Practice Address - Street 1:4 ELLIOT WAY, SUITE 100
Practice Address - Street 2:ELLIOT FAMILY MEDICINE AT MANCHESTER
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3551
Practice Address - Country:US
Practice Address - Phone:603-626-5113
Practice Address - Fax:603-622-5298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-19
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5600OtherMEDICARE GROUP PTAN