1588644181 NPI number — JUDITH WOOD COLE ARNP

Table of content: JUDITH WOOD COLE ARNP (NPI 1588644181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588644181 NPI number — JUDITH WOOD COLE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
JUDITH
Provider Middle Name:
WOOD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

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:
1588644181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03809-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-875-6151
Provider Business Mailing Address Fax Number:
603-875-2944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ALTON FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
82 MAIN STREET
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-875-6151
Provider Business Practice Location Address Fax Number:
603-875-2944
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  018480 23 03 , 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: 3083079 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2300461YPNH01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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