1417965468 NPI number — MAXFIELD CLINIC PROFESSIONAL ASSOCIATION

Table of content: (NPI 1417965468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417965468 NPI number — MAXFIELD CLINIC PROFESSIONAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXFIELD CLINIC PROFESSIONAL ASSOCIATION
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:
1417965468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 BELKNAP AVENUE
Provider Second Line Business Mailing Address:
MAXFIELD CLINIC
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-863-3434
Provider Business Mailing Address Fax Number:
603-863-1728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 BELKNAP AVENUE
Provider Second Line Business Practice Location Address:
MAXFIELD CLINIC
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-863-3434
Provider Business Practice Location Address Fax Number:
603-863-1728
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BISHOP
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CAMPBELL
Authorized Official Title or Position:
PRESIDENT OF BUSINESS
Authorized Official Telephone Number:
603-863-3434

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3436 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com