1679698765 NPI number — CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC

Table of content: (NPI 1679698765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679698765 NPI number — CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEW HAMPSHIRE KIDNEY CENTER,LLC
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:
1679698765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 SPRING STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-528-3738
Provider Business Mailing Address Fax Number:
603-524-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 SPRING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-3738
Provider Business Practice Location Address Fax Number:
603-524-8796
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISHAK
Authorized Official First Name:
NOSHI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO MEDICAL DIRECTOR
Authorized Official Telephone Number:
603-528-3738

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  1641 , 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: 30007939 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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