Provider Demographics
NPI: | 1194059055 |
---|---|
Name: | LITTLETON HOSPITAL ASSOCIATION |
Entity type: | Organization |
Organization Name: | LITTLETON HOSPITAL ASSOCIATION |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MAJKA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 603-444-9504 |
Mailing Address - Street 1: | PO BOX 160 |
Mailing Address - Street 2: | |
Mailing Address - City: | LITTLETON |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03561-0160 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-444-9000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 580 SAINT JOHNSBURY RD |
Practice Address - Street 2: | |
Practice Address - City: | LITTLETON |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03561-3437 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-444-9000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-09-25 |
Last Update Date: | 2016-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NH | 02790 | 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 208000000X, 208100000X, 2085B0100X, 208600000X, 208800000X, 208D00000X, 231H00000X, 363A00000X, 363L00000X, 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 30217571 | Medicaid |