Provider Demographics
NPI:1417332073
Name:PMC SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:PMC SURGICAL CENTER, LLC
Other - Org Name:GRANITE STATE SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-841-2314
Mailing Address - Street 1:7 WORKS WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1639
Mailing Address - Country:US
Mailing Address - Phone:603-692-3166
Mailing Address - Fax:603-692-3168
Practice Address - Street 1:255 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1543
Practice Address - Country:US
Practice Address - Phone:603-692-3166
Practice Address - Fax:603-692-3168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CURAM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-24
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3137547Medicaid