Basic Information
| Provider Information | |||||||||
| NPI: | 1811944523 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLETON HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | NORTH COUNTRY PRIMARY CARE RHC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032597627 | ||||||||
| FaxNumber: | 6032597561 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 SAINT JOHNSBURY RD | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035613437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034447070 | ||||||||
| FaxNumber: | 6034444075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 02/18/2016 | ||||||||
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| 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 | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 0303988 | 05 | VT | MEDICAID | 30518645 | 05 | NH | MEDICAID | 70008987 | 05 | NH | MEDICAID |