Provider Demographics
NPI:1427325729
Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Entity type:Organization
Organization Name:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEROT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-8977
Mailing Address - Street 1:1050 HOLT AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-5615
Mailing Address - Country:US
Mailing Address - Phone:603-663-2728
Mailing Address - Fax:603-663-8278
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-663-2728
Practice Address - Fax:603-663-8278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT HOSPITAL OF THE CITY OF MANCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-30
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00018332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1207512Y0NH01OtherANTHE BC DME
NH80002306Medicaid
2609052Y0NH01OtherANTHEM BC IV