Provider Demographics
NPI:1689764482
Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Entity Type:Organization
Organization Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Other - Org Name:HOME MEDICAL EQUIPMENT AND IV SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:G
Authorized Official - Last Name:CULLEROT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-8977
Mailing Address - Street 1:1070 HOLT AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5603
Mailing Address - Country:US
Mailing Address - Phone:603-663-2728
Mailing Address - Fax:603-663-5820
Practice Address - Street 1:1050 HOLT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-5615
Practice Address - Country:US
Practice Address - Phone:603-663-2728
Practice Address - Fax:603-663-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00018332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1207512Y0NH01OtherANTHEM BC DME
NH2609052Y0NH01OtherANTHEM BC IV
NH80002306Medicaid
NH0475980001Medicare NSC