1619038023 NPI number — GRANITE STATE EMERGENCY PHYSICIANS PC

Table of content: (NPI 1619038023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619038023 NPI number — GRANITE STATE EMERGENCY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANITE STATE EMERGENCY PHYSICIANS PC
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:
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:
1619038023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MCGREGOR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03102-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-663-6472
Provider Business Mailing Address Fax Number:
603-663-6645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MCGREGOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03102-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-663-6472
Provider Business Practice Location Address Fax Number:
603-663-6645
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAFFINO
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT MEDICAL DIRECTOR
Authorized Official Telephone Number:
603-663-6472

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DF6851 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 625983 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7838900 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9755331 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38691 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30214885 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50Y004300NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 612301300 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".




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