Provider Demographics
NPI:1801952692
Name:FOUR SEASONS ORTHOPAEDIC CENTER PA
Entity type:Organization
Organization Name:FOUR SEASONS ORTHOPAEDIC CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-883-0091
Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-883-0091
Mailing Address - Fax:
Practice Address - Street 1:7 STATE ROUTE 101A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-3132
Practice Address - Country:US
Practice Address - Phone:603-883-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR SEASONS ORTHOPAEDIC CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0132510004Medicare NSC
NHRE3689Medicare PIN