Provider Demographics
NPI:1932495504
Name:VALLEY REGIONAL HOSPITAL INC.
Entity Type:Organization
Organization Name:VALLEY REGIONAL HOSPITAL INC.
Other - Org Name:VALLEY REGIONAL UROLOGY
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:603-542-7771
Mailing Address - Fax:603-542-6731
Practice Address - Street 1:243 ELM 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:603-542-6777
Practice Address - Fax:603-542-6731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY REGIONAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-22
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019347Medicaid
NH3075542Medicaid
NHNH0647OtherMEDICARE PTAN