PMC Surgical Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PMC SURGICAL CENTER, LLC

Doing business as

Granite State SurgiCenter

Practice address

255 Route 108
Somersworth, NH 03878-1543

Phone

(603) 692-3166

Fax

(603) 692-3168

NPI assigned

Jul 24, 2015

Last updated

Oct 20, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

CURAM, LLCAs reported in NPPES

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

Authorized official

Name

Shannon Wiltshire

Title

Provider Relations Manager

Phone

(603) 841-2314

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Granite State SurgiCenter Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1417332073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 WORKS WAY",
            "city": "SOMERSWORTH",
            "state": "NH",
            "postal_code": "038781639",
            "telephone_number": "603-692-3166",
            "fax_number": "603-692-3168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 ROUTE 108",
            "city": "SOMERSWORTH",
            "state": "NH",
            "postal_code": "038781543",
            "telephone_number": "603-692-3166",
            "fax_number": "603-692-3168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMC SURGICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CURAM, LLC",
        "enumeration_date": "2015-07-24",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "WILTSHIRE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PROVIDER RELATIONS MANAGER",
        "authorized_official_telephone_number": "603-841-2314"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3137547",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asc.somersworth.fac.4@21697.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "PMC Surgical Center, LLC",
            "address_1": "7 Works Way",
            "city": "Somersworth",
            "state": "NH",
            "country_code": "US",
            "postal_code": "038781639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Granite State SurgiCenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vicki Tanner Petalas, FNP
• Pinewood Professionals, LLC
• Pinnacle Rehabilitation Network, LLC (Somersworth Physical Therapy)
• Mitchell Ned Pivor, M.D.
• Nicole Plante
• Primehaven LLC
• Aizhe Qian, RD
• Patrick Quann
• David Quint
• Malena Rachelle-Covill

• Ambulatory Surgical Clinic/Center in Somersworth, NH
• Providers in Somersworth, NH by specialty
• Ambulatory Surgical Clinic/Center in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.