Provider Demographics
NPI:1194733691
Name:CATHOLIC MEDICAL CENTER
Entity type:Organization
Organization Name:CATHOLIC MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COMMUNITY HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERTZIC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:603-663-8709
Mailing Address - Street 1:100 MCGREGOR ST
Mailing Address - Street 2:POISSON DENTAL FACILITY
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:603-663-6226
Mailing Address - Fax:603-663-7800
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:POISSON DENTAL FACILITY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-663-6226
Practice Address - Fax:603-663-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30312091Medicaid