Healthcare Provider Details

I. General information

NPI: 1205361052
Provider Name (Legal Business Name): MINIMALLY INVASIVE SURGERY CENTER OF N.E., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HAWTHORNE DR
BEDFORD NH
03110-6983
US

IV. Provider business mailing address

4 HAWTHORNE DR
BEDFORD NH
03110-6983
US

V. Phone/Fax

Practice location:
  • Phone: 603-218-1912
  • Fax: 603-218-1914
Mailing address:
  • Phone: 603-472-8888
  • Fax: 603-472-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 203-609-1168