MEDICARE: ELLIOT PHYSICIANS NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG2227	OTHER	NH	RR MEDICARE GRP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154310910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIOT PHYSICIANS NETWORK

Provider Business Mailing Address
First Line	:	15 CONSTITUTION DR
Second Line	:	ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
City	:	BEDFORD
State	:	NH
Zip	:	03110-6042
Country	:	US
Telephone Number	:	603-472-7233
Fax Number	:	603-472-9188

Provider Business Practice Location Address
First Line	:	15 CONSTITUTION DR
Second Line	:	ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
City	:	BEDFORD
State	:	NH
Zip	:	03110-6042
Country	:	US
Telephone Number	:	603-472-7233
Fax Number	:	603-472-9188

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS & FINANCE
Name	:	RICHARD P. HERMAN
Credential	:
Telephone Number	:	603-663-5766

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	06/20/2008

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Directions to “ELLIOT PHYSICIANS NETWORK ” Practice Location

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