Basic Information
| Provider Information | |||||||||
| NPI: | 1679642482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLETON HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LITTLETON REGIONAL HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035610160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034449000 | ||||||||
| FaxNumber: | 6034449392 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 SAINT JOHNSBURY RD | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034449000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MAJKA | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6034449504 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 02790 | NH | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 138260000 | 05 | ME | MEDICAID | 301302 | 01 | NH | ANTHEM BCBS PROVIDER # | OTHER | 322017 | 01 | NH | MVP PROVIDER # | OTHER | 0000783 | 05 | VT | MEDICAID | 0300008 | 05 | RI | MEDICAID | 54141 | 01 | NH | CIGNA PROVIDER # | OTHER | 7003629 | 05 | MA | MEDICAID | 80300008 | 05 | NH | MEDICAID | OP13013 | 05 | RI | MEDICAID | 01729235 | 05 | NY | MEDICAID | 0301302 | 05 | VT | MEDICAID | 7100353 | 05 | MA | MEDICAID |