Provider Demographics
NPI:1679526644
Name:ANDROSCOGGIN VALLEY HOSPITAL INC
Entity type:Organization
Organization Name:ANDROSCOGGIN VALLEY HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-752-5601
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3542
Mailing Address - Country:US
Mailing Address - Phone:603-752-2300
Mailing Address - Fax:603-752-8231
Practice Address - Street 1:7 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3542
Practice Address - Country:US
Practice Address - Phone:603-752-2300
Practice Address - Fax:603-752-8231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDROSCOGGIN VALLEY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH00050207K00000X, 207Q00000X, 207R00000X, 207V00000X, 207X00000X, 2085B0100X, 2085N0904X, 2085P0229X, 2085R0202X, 2085U0001X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30213098Medicaid
NH0449085OtherCIGNA
NHRE7915Medicare PIN
NH301310Medicare Oscar/Certification
NHRE8584Medicare PIN
NH30213098Medicaid
NHRE8048Medicare PIN
NHRE7802Medicare PIN
NHRE7890Medicare PIN
NHRE7878Medicare PIN