Provider Demographics
NPI:1619340163
Name:VALLEY REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:VALLEY REGIONAL HOSPITAL, INC
Other - Org Name:VALLEY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-542-7771
Mailing Address - Street 1:243 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2099
Mailing Address - Country:US
Mailing Address - Phone:603-543-6940
Mailing Address - Fax:603-543-6950
Practice Address - Street 1:7 DUNNING STREET
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2099
Practice Address - Country:US
Practice Address - Phone:603-543-6880
Practice Address - Fax:603-543-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3102826Medicaid