Healthcare Provider Details

I. General information

NPI: 1700218229
Provider Name (Legal Business Name): ANDROSCOGGIN VALLEY HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 PAGE HILL RD
BERLIN NH
03570-3531
US

IV. Provider business mailing address

59 PAGE HILL RD
BERLIN NH
03570-3531
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-2200
  • Fax: 603-752-1836
Mailing address:
  • Phone: 603-752-2200
  • Fax: 603-752-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number00050
License Number StateNH

VIII. Authorized Official

Name: JOHN MORRIS
Title or Position: CONTROLLER
Credential:
Phone: 603-326-5639