1023010501 NPI number — DR. RAY PHILIP HUMPHREY D.C.

Table of content: DR. RAY PHILIP HUMPHREY D.C. (NPI 1023010501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023010501 NPI number — DR. RAY PHILIP HUMPHREY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHREY
Provider First Name:
RAY
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1023010501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SOUTH RIVER ROAD
Provider Second Line Business Mailing Address:
UNIT 54
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-6751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-669-3428
Provider Business Mailing Address Fax Number:
603-669-3418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 SOUTH RIVER ROAD
Provider Second Line Business Practice Location Address:
UNIT 54
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-669-3428
Provider Business Practice Location Address Fax Number:
603-669-3418
Provider Enumeration Date:
08/13/2005

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: 111N00000X , with the licence number:  630-0401 , 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: 669047 . This is a "ACN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30254251 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6410727 . This is a "CIGNA IN SCRANTON, PENN." identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 05Y007836NH03 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1150474 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 761970 . This is a "CIGNA IN CONCORD, NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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