Provider Demographics
NPI:1235267451
Name:ANDROSCOGGIN VALLEY HOSPITAL
Entity Type:Organization
Organization Name:ANDROSCOGGIN VALLEY HOSPITAL
Other - Org Name:AVH SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-326-5601
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3542
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:603-326-5832
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2200
Practice Address - Fax:603-326-5832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDROSCOGGIN VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2009-03-17
Deactivation Date:2008-05-06
Deactivation Code:
Reactivation Date:2008-05-13
Provider Licenses
StateLicense IDTaxonomies
NH00050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2080367OtherCIGNA
NH900452OtherHARVARD PILGRIM
NHNH0022Medicare PIN
NH4129070002Medicare NSC