Provider Demographics
NPI:1679643894
Name:CONCORD HOSPITAL-LACONIA
Entity type:Organization
Organization Name:CONCORD HOSPITAL-LACONIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLOANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-227-7000
Mailing Address - Street 1:724 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2742
Mailing Address - Country:US
Mailing Address - Phone:603-524-5064
Mailing Address - Fax:
Practice Address - Street 1:724 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2742
Practice Address - Country:US
Practice Address - Phone:603-524-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORD HOSPITAL-LACONIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0590P333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30-04051OtherNCPDP
NH3078141Medicaid
NH3078141Medicaid