Provider Demographics
NPI:1023092053
Name:MARY HITCHCOCK MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MARY HITCHCOCK MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JANTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-650-5668
Mailing Address - Street 1:PO BOX 419112
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9112
Mailing Address - Country:US
Mailing Address - Phone:603-650-5000
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01799207R00000X, 261QE0002X, 261QH0700X, 273R00000X, 332B00000X, 282N00000X
NH02963416A0800X
VT09203416A0800X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No273R00000XHospital UnitsPsychiatric UnitGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE2206Medicaid
NH80300003Medicaid
NH80300900Medicaid
NHCD9167OtherRAILROAD MEDICARE
VT0300003Medicaid
VT0300900Medicaid
NH3076533Medicaid
NH30005466Medicaid
VTDE1531OtherRAILROAD MEDICARE
NH30011095Medicaid
NH30210001Medicaid
NH30210001Medicaid
300003B000000Medicare PIN
NH80300900Medicaid
NH80300003Medicaid
VT0RE2206Medicaid
NH30011095Medicaid
NH0688170002Medicare NSC