NPIMap

Organization Active NPI

Elliot Professional Services

  • Oral and Maxillofacial Surgery (Dentist)
  • Manchester, NH
National Provider Identifier
1255314951
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ELLIOT PROFESSIONAL SERVICES
Practice address
1 Elliot Way
Elliot Oms Center
Manchester, NH 03103-3502
Phone
(603) 625-8462
Fax
(603) 669-2711
NPI assigned
Nov 28, 2005
Last updated
Jun 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ELLIOT PROFESSIONAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard P. Herman
Title
Director of Operations and Finance
Phone
(603) 663-4904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

1 Elliot Way
Elliot Oms Center
Manchester, NH 03103-3502

Mailing address

1 Elliot Way
Elliot Oms Center
Manchester, NH 03103-3502
Phone (603) 625-8462

Other identifiers 2

IdentifierTypeStateIssuer
CK3360OtherNHRR MEDICARE
30313860MedicaidNH

Other names 1

  • ELLIOT OMS CENTER Other name

National Provider Directory

National Provider Directory
Tax ID family
Elliot Professional Ser35 organizations share this tax ID, including this one
Part of
Elliot Professional Ser

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1255314951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "address_2": "ELLIOT OMS CENTER",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033502",
            "telephone_number": "603-625-8462",
            "fax_number": "603-669-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "address_2": "ELLIOT OMS CENTER",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033502",
            "telephone_number": "603-625-8462",
            "fax_number": "603-669-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOT PROFESSIONAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLIOT PROFESSIONAL SERVICES",
        "enumeration_date": "2005-11-28",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "HERMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS AND FINANCE",
        "authorized_official_telephone_number": "603-663-4904"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CK3360",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30313860",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELLIOT OMS CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.