Provider Demographics
NPI:1073569810
Name:ALICE PECK DAY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ALICE PECK DAY MEMORIAL HOSPITAL
Other - Org Name:PHYSICIAN PRACTICES AT ALICE PECK DAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-448-3121
Mailing Address - Street 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-3122
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:10 ALICE PECK DAY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-448-3122
Practice Address - Fax:603-448-7491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALICE PECK DAY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207X00000X, 2083X0100X, 208600000X, 208M00000X, 208VP0000X
NH00016207Q00000X, 207R00000X, 207X00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE0680Medicare PIN