Provider Demographics
NPI:1922184928
Name:LRGHEALTHCARE
Entity Type:Organization
Organization Name:LRGHEALTHCARE
Other - Org Name:LAKES REGION GENERAL HOSPITAL PROFESSIONAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EVP-CFO
Authorized Official - Phone:603-524-3211
Mailing Address - Street 1:PO BOX 4144
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-4144
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:
Practice Address - Street 1:80 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3235
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LRGHEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00061207P00000X, 207RS0012X, 207ZP0102X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHLAKE992535OtherANTHEM
NHLAKE225306OtherANTHEM
NHLAKE493180OtherANTHEM
NH3021080Medicaid
NH30210989Medicaid
NH55616OtherCIGNA
NHEMER990106OtherANTHEM
NHNH9391Medicare ID - Type Unspecified
NHEMER990106OtherANTHEM