1770576688 NPI number — JAMES S HEATH M.D.

Table of content: JAMES S HEATH M.D. (NPI 1770576688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770576688 NPI number — JAMES S HEATH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEATH
Provider First Name:
JAMES
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1770576688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 FARLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIS
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03049-5916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-889-2062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 1538
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-889-4431
Provider Business Practice Location Address Fax Number:
603-889-1572
Provider Enumeration Date:
08/25/2005

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: 207ZP0102X , with the licence number:  5692 , 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: 6382 . This is a "CIGNA/HEATHSOURCE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 783914 . This is a "MVP INSURANCE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30002352 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0106484Y0NH01 . This is a "BC/BS#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 11-04304 . This is a "UNITED HEALTH ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 220013061 . This is a "RAILRAOD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 005692 . This is a "TUFTS ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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