Provider Demographics
NPI:1417993494
Name:CONCORD AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CONCORD AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-227-7000
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5071
Mailing Address - Country:US
Mailing Address - Phone:603-415-9460
Mailing Address - Fax:603-415-9465
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5071
Practice Address - Country:US
Practice Address - Phone:603-415-9460
Practice Address - Fax:603-415-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03034261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH18Y007689NH01OtherANTHEM PROVIDER NUMBER
NH73992OtherCIGNA PROVIDER NUMBER
NH002489615001OtherUNITED HEALTHCARE PROVIDE
NH2241466OtherFIRST HEALTH
NH7170718OtherAETNA
NH30623452Medicaid
NH00066359OtherMARTINS POINT PROVIDER
NH904456OtherHARVARD PILGRIM PROVIDER
NH30623452Medicaid