1518913607 NPI number — HCA HEALTH SERVICES OF NEW HAMPSHIRE INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518913607 NPI number — HCA HEALTH SERVICES OF NEW HAMPSHIRE INC

Employer Identification Number (EIN):

Provider Organization Name:

HCA HEALTH SERVICES OF NEW HAMPSHIRE INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

PORTSMOUTH REGIONAL HOSPITAL

Provider Other Organization Name Type Code:

3

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:

1518913607

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/24/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 7004

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PORTSMOUTH

Provider Business Mailing Address State Name:

NH

Provider Business Mailing Address Postal Code:

03802-7004

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-436-5110

Provider Business Mailing Address Fax Number:

603-433-5245

Provider First Line Business Practice Location Address:

333 BORTHWICK AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PORTSMOUTH

Provider Business Practice Location Address State Name:

NH

Provider Business Practice Location Address Postal Code:

03801-7128

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

603-436-5110

Provider Business Practice Location Address Fax Number:

603-433-5245

Provider Enumeration Date:

05/26/2006

Authorized Official Last Name:

WIESMANN

Authorized Official First Name:

JACOB

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

603-433-4010

• Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1002783 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 300029 . This is a "BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 100879200 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
• Identifier: 900250 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
• Identifier: 01546056 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 80300029 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
• Identifier: 902162100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 905893 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
• Identifier: POR0029N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 1007770520003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 903299 . This is a "TUFT" identifier . This identifiers is of the category "OTHER".
• Identifier: 000593843X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 140140000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
• Identifier: 0065372 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".