1306449749 NPI number — VMD PRIMARY PROVIDERS NEW HAMPSHIRE, PLLC

Table of content: (NPI 1306449749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306449749 NPI number — VMD PRIMARY PROVIDERS NEW HAMPSHIRE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VMD PRIMARY PROVIDERS NEW HAMPSHIRE, 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:
1306449749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S CLARK ST STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60603-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-810-0900
Provider Business Mailing Address Fax Number:
603-514-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1298 HOOKSETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOKSETT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03106-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-810-0900
Provider Business Practice Location Address Fax Number:
603-514-5741
Provider Enumeration Date:
11/18/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
I
Authorized Official Title or Position:
SENIOR DIRECTOR
Authorized Official Telephone Number:
706-513-4897

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)