1427020395 NPI number — SEACOAST RADIOLOGY, PA

Table of content: (NPI 1427020395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427020395 NPI number — SEACOAST RADIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEACOAST RADIOLOGY, PA
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:
6
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:
1427020395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9567
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:
03108-9567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-516-1307
Provider Business Mailing Address Fax Number:
603-516-1308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-516-1307
Provider Business Practice Location Address Fax Number:
603-516-4221
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIASCHINI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
603-516-1307

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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: 82304030 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164 . This is a "CIGNA HEALTHCARE HMO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: DOVE304030 . This is a "ANTHEM BC & BS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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