1073869830 NPI number — THE LOVELACE INSTITUTE FOR SPINE AND SPORTS INJURIES, INCORPORATED

Table of content: (NPI 1073869830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073869830 NPI number — THE LOVELACE INSTITUTE FOR SPINE AND SPORTS INJURIES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LOVELACE INSTITUTE FOR SPINE AND SPORTS INJURIES, INCORPORATED
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:
THE SEACOAST SPINE & SPORTS INJURIES CLINIC
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:
1073869830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 196
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON BAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03810-0196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-431-4200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 PORTWALK PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-3989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-431-4200
Provider Business Practice Location Address Fax Number:
603-431-4202
Provider Enumeration Date:
07/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELACE
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
PRESIDENT / CLINIC DIRECTOR
Authorized Official Telephone Number:
503-803-3048

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  894 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X , with the licence number: 894 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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