Provider Demographics
NPI:1063850345
Name:UPPER CONNECTICUT VALLEY HOSPITAL
Entity Type:Organization
Organization Name:UPPER CONNECTICUT VALLEY HOSPITAL
Other - Org Name:AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-388-4242
Mailing Address - Street 1:181 CORLISS LN
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3207
Mailing Address - Country:US
Mailing Address - Phone:603-237-4971
Mailing Address - Fax:603-237-4452
Practice Address - Street 1:181 CORLISS LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3207
Practice Address - Country:US
Practice Address - Phone:603-237-4971
Practice Address - Fax:603-237-4452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER CONNECTICUT VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00592261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical