MEDICARE: CATHOLIC MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1831381987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC MEDICAL CENTER

Provider Business Mailing Address
First Line	:	11 KIMBALL DR
Second Line	:
City	:	HOOKSETT
State	:	NH
Zip	:	03106-2603
Country	:	US
Telephone Number	:	603-663-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 KIMBALL DR
Second Line	:
City	:	HOOKSETT
State	:	NH
Zip	:	03106-2603
Country	:	US
Telephone Number	:	603-663-1990
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. ANDRE THERRIEN
Credential	:
Telephone Number	:	603-663-8779

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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Directions to “CATHOLIC MEDICAL CENTER ” Practice Location

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