Provider Demographics
NPI:1356308019
Name:ASSOCIATES IN SURGERY & GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN SURGERY & GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FACMPE
Authorized Official - Phone:603-543-3501
Mailing Address - Street 1:7 DUNNING ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2016
Mailing Address - Country:US
Mailing Address - Phone:603-543-3501
Mailing Address - Fax:603-542-6486
Practice Address - Street 1:7 DUNNING ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2016
Practice Address - Country:US
Practice Address - Phone:603-543-3501
Practice Address - Fax:603-542-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000328Medicaid
VTASSO00003879OtherVERMONT BLUE SHIELD
NH50Y387900NH01OtherANTHEM BLUE SHIELD
VT0003879Medicaid
NHCB1449OtherRAILROAD MEDICARE
VT0003879Medicaid