1003946112 NPI number — WAYNE KIERAN CUNNINGHAM L.C.M.H.C., L.A.D.C.

Table of content: WAYNE KIERAN CUNNINGHAM L.C.M.H.C., L.A.D.C. (NPI 1003946112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003946112 NPI number — WAYNE KIERAN CUNNINGHAM L.C.M.H.C., L.A.D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
WAYNE
Provider Middle Name:
KIERAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.M.H.C., L.A.D.C.
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:
1003946112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 476
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CONWAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03860-0476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-356-9955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 MAIN STREET
Provider Second Line Business Practice Location Address:
EASTERN SLOPE INN
Provider Business Practice Location Address City Name:
NORTH CONWAY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-356-9955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

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: 101YA0400X , with the licence number:  0331 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 237 , 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: 30014439 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com