1548686611 NPI number — MRS. TERRY RUTH AVERY PTA

Table of content: MRS. TERRY RUTH AVERY PTA (NPI 1548686611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548686611 NPI number — MRS. TERRY RUTH AVERY PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVERY
Provider First Name:
TERRY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TWOMBLY
Provider Other First Name:
TERRY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548686611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 DOVER POINT RD.
Provider Second Line Business Mailing Address:
ST. ANN (SAINT ANN HEALTHCARE CENTER)
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-742-2612
Provider Business Mailing Address Fax Number:
603-743-3055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 DOVER POINT RD.
Provider Second Line Business Practice Location Address:
ST. ANN HEALTHCARE CTR
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-2612
Provider Business Practice Location Address Fax Number:
603-743-3055
Provider Enumeration Date:
03/12/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  0007 , 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)