Provider Demographics
NPI:1548442213
Name:ELLIOT PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:ELLIOT PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:33 S COMMERCIAL ST STE 401
Mailing Address - Street 2:ELLIOT PALLIATIVE CARE SERVICES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2626
Mailing Address - Country:US
Mailing Address - Phone:603-622-3781
Mailing Address - Fax:603-663-4070
Practice Address - Street 1:33 S COMMERCIAL ST STE 401
Practice Address - Street 2:ELLIOT PALLIATIVE CARE SERVICES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2626
Practice Address - Country:US
Practice Address - Phone:603-622-3781
Practice Address - Fax:603-663-4070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30216263Medicaid
CK3360OtherRR MEDICARE
NHRE6661Medicare PIN