Healthcare Provider Details

I. General information

NPI: 1467743427
Provider Name (Legal Business Name): LRGHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MAPLE ST SUITE 100
GILFORD NH
03249-6580
US

IV. Provider business mailing address

PO BOX 2011
LACONIA NH
03247-2011
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-9011
  • Fax: 603-527-5743
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number8510
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number332M
License Number StateNH

VIII. Authorized Official

Name: HENRY D LIPMAN
Title or Position: EVP-CFO
Credential:
Phone: 603-527-2802