1811264559 NPI number — WEYMOUTH SURGICAL LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811264559 NPI number — WEYMOUTH SURGICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEYMOUTH SURGICAL 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:
1811264559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BIRCH ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-965-4505
Provider Business Mailing Address Fax Number:
603-965-4063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-965-4505
Provider Business Practice Location Address Fax Number:
603-965-4063
Provider Enumeration Date:
11/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEYMOUTH
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-818-8914

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  219696 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 12895 , 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: 30224519 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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