Provider Demographics
NPI:1154496909
Name:CARROLL COUNTY GASTROENTEROLOGY, INC.
Entity Type:Organization
Organization Name:CARROLL COUNTY GASTROENTEROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-569-9681
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-0878
Mailing Address - Country:US
Mailing Address - Phone:603-569-9681
Mailing Address - Fax:603-569-9384
Practice Address - Street 1:29 UNION ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:603-569-9681
Practice Address - Fax:603-569-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30210483Medicaid
NHRE6715Medicare ID - Type Unspecified
NH30210483Medicaid