Provider Demographics
NPI:1861489437
Name:UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-237-4971
Mailing Address - Street 1:181 CORLISS LANE
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576
Mailing Address - Country:US
Mailing Address - Phone:603-237-4971
Mailing Address - Fax:603-237-4452
Practice Address - Street 1:181 CORLISS LANE
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576
Practice Address - Country:US
Practice Address - Phone:603-237-4971
Practice Address - Fax:603-237-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00592282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078954Medicaid
0049127OtherCIGNA
30 1300OtherANTHEM
VT59472OtherVT BCBS EKG
ME138560000Medicaid
VT301300OtherVT BCBS
VT49735OtherVT BCBS ANESTHESIOLOGIST
926356OtherMVP
VT00644OtherVTW ED#
VT0301300Medicaid
VT5129902OtherVMC
NH030 1300OtherCAH
VT59471OtherVT BCBS WALK IN CLINIC
VT301300OtherVTW
VT39632OtherVT BCBS ED#
VT49790OtherVT BCBS SURGERY
926356OtherMVP
VT39632OtherVT BCBS ED#
NHNH0033Medicare ID - Type Unspecified