Provider Demographics
NPI:1568438349
Name:ELLIOT PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:ELLIOT PROFESSIONAL SERVICES
Other - Org Name:GREATER AMHERST IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION & 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:603-663-4904
Mailing Address - Street 1:MEETING PLACE PLAZA 199 - ROUTE 101
Mailing Address - Street 2:GREATER AMHERST IMAGING
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-249-3000
Mailing Address - Fax:603-249-3021
Practice Address - Street 1:MEETING PLACE PLAZA 199 - ROUTE 101
Practice Address - Street 2:GREATER AMHERST IMAGING
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031
Practice Address - Country:US
Practice Address - Phone:603-249-3000
Practice Address - Fax:603-249-3021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PROFESSIONAL S ERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-23
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH626438OtherHPHC GRP
NH3206971OtherAETNA GRP
NHP00009327OtherRR MEDICARE GRP
NH60146303OtherW/C DOL GRP
NH15Y002259NH02OtherANTHEM GRP
NH667222OtherCIGNA GRP
NH30812256Medicaid
NH3206971OtherAETNA GRP