Healthcare Provider Details

I. General information

NPI: 1245291350
Provider Name (Legal Business Name): ELLIOT 1 DAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 QUEEN CITY AVENUE
MANCHESTER NH
03101
US

IV. Provider business mailing address

185 QUEEN CITY AVENUE
MANCHESTER NH
03101
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-3000
  • Fax: 603-626-4300
Mailing address:
  • Phone: 603-663-3000
  • Fax: 603-626-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number02840
License Number StateNH

VIII. Authorized Official

Name: BEVERLY PRIMEAU
Title or Position: ADMINISTRATOR
Credential: RN, MBA
Phone: 603-663-3580