Basic Information
| Provider Information | |||||||||
| NPI: | 1831490309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALICE PECK DAY MEMORIAL HOSPITAL | ||||||||
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| OtherOrganizationName: | APD HAND AND UPPER EXTREMITY SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 ALICE PECK DAY DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483121 | ||||||||
| FaxNumber: | 6034487462 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 BILLINGS FARM RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | WHITE RIVER JUNCTION | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050015400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022992640 | ||||||||
| FaxNumber: | 8022992643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2010 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | MOONEY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6034483121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALICE PECK DAY MEMORIAL HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 30218547 | 05 | NH | MEDICAID | 1018493 | 05 | VT | MEDICAID |