Healthcare Provider Details

I. General information

NPI: 1194016162
Provider Name (Legal Business Name): LRGHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

85 SPRING ST
LACONIA NH
03246-3113
US

IV. Provider business mailing address

PO BOX 2010
LACONIA NH
03247-2010
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-7402
  • Fax: 603-524-0945
Mailing address:
  • Phone: 603-524-3211
  • Fax: 603-527-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

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