1780648915 NPI number — SOUTHERN NEW HAMPSHIRE RADIOLOGY CONSULTANTS PC

Table of content: (NPI 1780648915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780648915 NPI number — SOUTHERN NEW HAMPSHIRE RADIOLOGY CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN NEW HAMPSHIRE RADIOLOGY CONSULTANTS 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:
NEW HAMPSHIRE RADIOLOGY ASSOCIATES, PLLC
Provider Other Organization Name Type Code:
5
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:
1780648915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 RIVERWAY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-6768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-627-1661
Provider Business Mailing Address Fax Number:
603-669-6944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 RIVERWAY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-627-1661
Provider Business Practice Location Address Fax Number:
603-669-6944
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELAKIS
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE COORDINATOR
Authorized Official Telephone Number:
603-627-1661

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CC8960 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30009767 . This is a "MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 589255 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 610545 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: RE4181 . This is a "MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 29466 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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