1548299183 NPI number — NASHUA PAIN MANAGEMENT CORPORATION

Table of content: (NPI 1548299183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548299183 NPI number — NASHUA PAIN MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASHUA PAIN MANAGEMENT CORPORATION
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:
1548299183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48740-0184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-455-3320
Provider Business Mailing Address Fax Number:
603-455-3320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-882-9872
Provider Business Practice Location Address Fax Number:
603-465-7829
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GELLER
Authorized Official First Name:
AARON
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-882-9872

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 125324400 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 433740 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G03799 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30212601 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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