Provider Demographics
NPI:1447676754
Name:GRANITE STATE EXPRESS CARE LLC
Entity type:Organization
Organization Name:GRANITE STATE EXPRESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZINZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-335-8103
Mailing Address - Street 1:120 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867
Mailing Address - Country:US
Mailing Address - Phone:603-330-7040
Mailing Address - Fax:
Practice Address - Street 1:120 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867
Practice Address - Country:US
Practice Address - Phone:603-330-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center