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Organization Active NPI

Elliot Professional Services

  • Plastic and Reconstructive Surgery Physician
  • Manchester, NH
National Provider Identifier
1336101534
Registry record updated Mar 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
ELLIOT PROFESSIONAL SERVICES
Practice address
185 Queen City Ave
Wound Management Center
Manchester, NH 03101-7100
Phone
(603) 663-3630
Fax
(603) 663-3669
NPI assigned
Apr 4, 2006
Last updated
Mar 18, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
ELLIOT PROFESSIONAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

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 & Finance
Phone
(603) 663-4904

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X NH
Plastic and Reconstructive Surgery Physician 2086S0122X Primary

Addresses

Primary practice location

185 Queen City Ave
Wound Management Center
Manchester, NH 03101-7100

Mailing address

185 Queen City Ave
Wound Management Center
Manchester, NH 03101-7100
Phone (603) 663-3630

Other identifiers 2

IdentifierTypeStateIssuer
30212489MedicaidNH
CK3360OtherNHRR MEDICARE

Other names 1

  • Wound Management 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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1336101534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "address_2": "WOUND MANAGEMENT CENTER",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017100",
            "telephone_number": "603-663-3630",
            "fax_number": "603-663-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "address_2": "WOUND MANAGEMENT CENTER",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017100",
            "telephone_number": "603-663-3630",
            "fax_number": "603-663-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIOT PROFESSIONAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLIOT PROFESSIONAL SERVICES",
        "enumeration_date": "2006-04-04",
        "last_updated": "2011-03-18",
        "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 & FINANCE",
        "authorized_official_telephone_number": "603-663-4904"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "NH",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30212489",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CK3360",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wound Management 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 Mar 18, 2011; 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.