Provider Demographics
NPI:1730140112
Name:LGH HEALTH ENTERPRISES INC.
Entity Type:Organization
Organization Name:LGH HEALTH ENTERPRISES INC.
Other - Org Name:WOMEN'S HEALTH IMAGING SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-MANAGED CARE DEPT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-683-4000
Mailing Address - Street 1:140 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1504
Mailing Address - Country:US
Mailing Address - Phone:978-475-5213
Mailing Address - Fax:978-475-6765
Practice Address - Street 1:140 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1504
Practice Address - Country:US
Practice Address - Phone:978-475-5213
Practice Address - Fax:978-475-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA08733261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALG327035Medicare ID - Type UnspecifiedMEDICARE