1114952942 NPI number — NEW HAMPSHIRE KNEE CENTER PC

Table of content: (NPI 1114952942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114952942 NPI number — NEW HAMPSHIRE KNEE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HAMPSHIRE KNEE CENTER PC
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:
1114952942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03216-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-735-6060
Provider Business Mailing Address Fax Number:
603-735-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-968-7377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-968-7377

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  8013 , 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: 9760024 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009962 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 247275800 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 545141 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 545141 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 80009962 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200023235 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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