1548461692 NPI number — PARKLAND PHYSICIAN SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548461692 NPI number — PARKLAND PHYSICIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKLAND PHYSICIAN SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARKLAND PHYSICIAN SERVICES OF SALEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548461692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-421-3419
Provider Business Mailing Address Fax Number:
603-894-0535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-421-3419
Provider Business Practice Location Address Fax Number:
603-894-0535
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
703-650-2907

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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