1568584290 NPI number — PORTSMOUTH ANESTHESIA ASSOCIATES PA

Table of content: (NPI 1568584290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568584290 NPI number — PORTSMOUTH ANESTHESIA ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTSMOUTH ANESTHESIA ASSOCIATES PA
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:
1568584290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845343
Provider Second Line Business Mailing Address:
PORTSMOUTH ANETHESIA ASSOCIATES
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-5343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-720-1664
Provider Business Mailing Address Fax Number:
207-753-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BORTHWICK AVENUE
Provider Second Line Business Practice Location Address:
PORTSMOUTH ANESTHESIA ASSOCIATES
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:
603-749-0043
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MENKE MD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
603-475-2010

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30007940 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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