Provider Demographics
NPI:1841320207
Name:FOUR SEASONS ORTHOPAEDIC CENTER PLLC
Entity type:Organization
Organization Name:FOUR SEASONS ORTHOPAEDIC CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
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:603-881-3739
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-883-0091
Practice Address - Fax:603-881-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0132510001Medicare NSC
RE3689Medicare PIN