1033466784 NPI number — KEADY FAMILY PRACTICE, LLC

Table of content: (NPI 1033466784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033466784 NPI number — KEADY FAMILY PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEADY FAMILY PRACTICE, LLC
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:
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:
1033466784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03743-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-863-7777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-863-7777
Provider Business Practice Location Address Fax Number:
603-769-3406
Provider Enumeration Date:
08/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEADY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
603-826-3434

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SF0001X , with the licence number: 052532-23 , 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)