1598919847 NPI number — PATRICIA E KELLOGG PA-C

Table of content: PATRICIA E KELLOGG PA-C (NPI 1598919847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598919847 NPI number — PATRICIA E KELLOGG PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLOGG
Provider First Name:
PATRICIA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1598919847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
PATIENT FINANCIAL SERVICES
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-259-7627
Provider Business Mailing Address Fax Number:
603-259-7561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 ST. JOHNSBURY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-444-7070
Provider Business Practice Location Address Fax Number:
603-444-4075
Provider Enumeration Date:
11/13/2008

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: 363AM0700X , with the licence number:  0125P , 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: 0303988 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30518645 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: NH0783 . This is a "MEDICARE B GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 70008987 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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