1568573731 NPI number — PATRICIA E MURRAY D.O.

Table of content: PATRICIA E MURRAY D.O. (NPI 1568573731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568573731 NPI number — PATRICIA E MURRAY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
PATRICIA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1568573731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03818-0244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-447-3112
Provider Business Mailing Address Fax Number:
603-447-3118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 PLEASANT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03818-0244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-447-3112
Provider Business Practice Location Address Fax Number:
603-447-3112
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  12804 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 203537975 . This is a "GROUP NPI" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 04Y008665NH01 . This is a "ANTHEM OF NEW HAMPSHIRE #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 203537975 . This is a "TAX ID #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 294660099 . This is a "MEDICAID OF MAINE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30223886 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060208 . This is a "ANTHEM OF MAINE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: RE8511 . This is a "GROUP MEDICARE #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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