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General NPI Number Information
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NPI Number | 1649598012
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Entity Type | Organization
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Legal Business Name | LRGHEALTHCARE
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 85 SPRING ST SUITE 302
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City | LACONIA
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State | NH
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Zip | 03246-3169
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Country | US
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Telephone | 603-524-8660
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Fax | 603-528-6220
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Provider Business Mailing Address
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Address Line | PO BOX 1327
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City | LACONIA
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State | NH
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Zip | 03247-1327
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Country | US
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Telephone | 603-524-3211
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Fax | 603-527-7038
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Authorized Official
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Title or Position | EVP-CFO
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Name | HENRY D LIPMAN
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Credential |
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Telephone | 603-527-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 03021
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License Number State | NH
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