Provider Demographics
NPI:1285928259
Name:CATHOLIC MEDICAL CENTER
Entity type:Organization
Organization Name:CATHOLIC MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-6180
Mailing Address - Street 1:195 MCGREGOR ST
Mailing Address - Street 2:SUITE LL22
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3748
Mailing Address - Country:US
Mailing Address - Phone:603-663-8701
Mailing Address - Fax:603-663-8766
Practice Address - Street 1:177 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5321
Practice Address - Country:US
Practice Address - Phone:603-782-7414
Practice Address - Fax:603-518-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30518396Medicaid
NH30212269Medicaid
NH30518397Medicaid
NH30518397Medicaid
NH30518396Medicaid
NH301822Medicare PIN