Basic Information
| Provider Information | |||||||||
| NPI: | 1881635837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERRIMACK EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ELLIOT WAY | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036632830 | ||||||||
| FaxNumber: | 6036631849 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ELLIOT WAY | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036632830 | ||||||||
| FaxNumber: | 6036631849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAXTER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6036632830 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
| ID | Type | State | Issuer | Description | 67686 | 01 | NH | GROUP CIGNA | OTHER | 30212549 | 05 | NH | MEDICAID | 697851 | 01 | NH | GROUP TUFTS | OTHER | MERR99465 | 01 | NH | GROUP ANTHEM BCBS | OTHER |