# ELLIOT PHYSICIANS NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ELLIOT PHYSICIANS NETWORK
- **Other names:** Elliot Family Medicine at Glen Lake
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588655567
- **Legal business name:** ELLIOT PHYSICIANS NETWORK
- **Authorized official:** RICHARD P. HERMAN (DIRECTOR OF OPERATIONS & FINANCE)
- **Authorized official phone:** (603) 663-4904

## Contact information

- **Practice address:** 89 S MAST RD, ELLIOT FAMILY MEDICINE AT GLEN LAKE, GOFFSTOWN, NH 03045-6102
- **Practice address phone:** (603) 497-5661
- **Practice address fax:** (603) 497-5740
- **Mailing address:** 89 S MAST RD, ELLIOT FAMILY MEDICINE AT GLEN LAKE, GOFFSTOWN, NH 03045-6102
- **Mailing address phone:** (603) 497-5661
- **Mailing address fax:** (603) 497-5740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2005
- **Last updated:** 06/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30211110 | — | NH |
| 01 | — | CG2227 | RR MEDICARE GROUP | — |