1568480622 NPI number — SPEARE MEMORIAL HOSPITAL

Table of content: (NPI 1568480622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568480622 NPI number — SPEARE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEARE MEMORIAL HOSPITAL
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:
TENNEY MOUNTAIN ORTHOPEDICS CLINIC
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 Information

NPI Number:
1568480622
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:
PO BOX 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03216-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-735-6060
Provider Business Mailing Address Fax Number:
603-735-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 AVERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-536-5803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRITIKOS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
603-536-1120

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  9435 , 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: 758313 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30211268 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52028603 . This is a "ANTHEM" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: CG6192 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2874405 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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