Provider Demographics
NPI:1558351619
Name:ELLIOT PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ELLIOT PHYSICIANS NETWORK
Other - Org Name:ELLIOT FAMILY MEDICINE AT BEDFORD COMMONS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-5766
Mailing Address - Street 1:25 S RIVER RD
Mailing Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD COMMONS
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6708
Mailing Address - Country:US
Mailing Address - Phone:603-626-4392
Mailing Address - Fax:603-626-4462
Practice Address - Street 1:25 S RIVER RD
Practice Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD COMMONS
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6708
Practice Address - Country:US
Practice Address - Phone:603-626-4392
Practice Address - Fax:603-626-4462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PHYSICIANS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG2227OtherRR MEDICARE GROUP #
NH30210986Medicaid
CG2227OtherRR MEDICARE GROUP #