1386826188 NPI number — THE COUPLES CENTER, PLLC

Table of content: (NPI 1386826188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386826188 NPI number — THE COUPLES CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COUPLES CENTER, PLLC
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:
1386826188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 MAPLEWOOD AVE
Provider Second Line Business Mailing Address:
BUILDING A
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-3787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-431-7131
Provider Business Mailing Address Fax Number:
207-439-4113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MAPLEWOOD AVE.
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-431-7131
Provider Business Practice Location Address Fax Number:
207-439-4113
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAGER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
RIVCHUN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
603-431-7131

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  202 , 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: 1400525YONHO1 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 613214400 . This is a "US DEPT OF LABOR -- FECA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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