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NPI Code Detail

MEDICARE: MEC CONCORD OBS LLC

MEDICARE: MEC CONCORD OBS LLC
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
1261QS0132XOphthalmologic Surgery Clinic/Center
2261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1225979123
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEC CONCORD OBS LLC
Provider Business Mailing Address
First Line : 250 RIVER RD
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-2423
Country : US
Telephone Number : 603-668-2020
Fax Number :
Provider Business Practice Location Address
First Line : 250 RIVER RD
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-2423
Country : US
Telephone Number : 603-668-2020
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : JACKIE WIEDEMANN
Credential :
Telephone Number : 816-610-8511
Provider Enumeration Date : 04/03/2026
Last Update Date : 05/28/2026

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Directions to “MEC CONCORD OBS LLC ” Practice Location

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