Healthcare Provider Details

I. General information

NPI: 1417993494
Provider Name (Legal Business Name): CONCORD AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COMMERCIAL ST SUITE 301
CONCORD NH
03301-5071
US

IV. Provider business mailing address

60 COMMERCIAL ST SUITE 301
CONCORD NH
03301-5071
US

V. Phone/Fax

Practice location:
  • Phone: 603-415-9460
  • Fax: 603-415-9465
Mailing address:
  • Phone: 603-415-9460
  • Fax: 603-415-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number03034
License Number StateNH

VIII. Authorized Official

Name: MR. BRUCE BURNS
Title or Position: AUTHORIZED OFFICIAL OF CORPORATION
Credential:
Phone: 603-227-7000