1962453043 NPI number — JASON HARRIS APRN

Table of content: JASON HARRIS APRN (NPI 1962453043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962453043 NPI number — JASON HARRIS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
JASON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

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:
1962453043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03061-3677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-577-7900
Provider Business Mailing Address Fax Number:
603-577-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 WINDHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03076-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-577-2273
Provider Business Practice Location Address Fax Number:
603-635-5441
Provider Enumeration Date:
05/13/2006

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: 363L00000X , with the licence number:  236916 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 056047-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 056047-23 , 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: 40Y013345NH01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30346481 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 433002799 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00697980 . This is a "RAILROAD MCARE THRU SEACOAST" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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