1134155872 NPI number — SEACOAST EMERGENCY PHYSICIANS, PC

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 1134155872 NPI number — SEACOAST EMERGENCY PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEACOAST 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:
1134155872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 LAFAYETTE RD
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03842-3344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-926-0088
Provider Business Mailing Address Fax Number:
603-924-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 CENTRAL AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-740-2163
Provider Business Practice Location Address Fax Number:
603-740-2246
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACCAUSLAND
Authorized Official First Name:
OWEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
603-740-2163

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: 30011120 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE0476 . This is a "RAILROAD MCARE GROUP ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 9705015 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018881700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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