1588867667 NPI number — HANOVER CONTINUITY CLINIC, PLLC

Table of content: (NPI 1588867667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588867667 NPI number — HANOVER CONTINUITY CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANOVER CONTINUITY CLINIC, PLLC
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:
1588867667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 LYME RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03755-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-643-3320
Provider Business Mailing Address Fax Number:
603-643-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 LYME RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03755-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-643-3320
Provider Business Practice Location Address Fax Number:
603-643-3301
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARZ
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
JULES
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
603-643-3320

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  10169 , 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: 10169 . This is a "MEDICAL LICENCE NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 12968 . This is a "LICENSE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0000467 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 420011112 . This is a "MEDICAL LICENCE NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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