Healthcare Provider Details

I. General information

NPI: 1982027579
Provider Name (Legal Business Name): ELLIOT AFTER HOURS AT RAYMOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FREETOWN RD
RAYMOND NH
03077-2358
US

IV. Provider business mailing address

15 FREETOWN RD
RAYMOND NH
03077-2358
US

V. Phone/Fax

Practice location:
  • Phone: 603-895-8000
  • Fax: 603-895-8099
Mailing address:
  • Phone: 603-895-8000
  • Fax: 603-895-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number03977
License Number StateNH

VIII. Authorized Official

Name: RICHARD P HERMAN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 603-663-4904