1467436089 NPI number — GOODWIN COMMUNITY HEALTH

Table of content: JOHN R CLAUSSEN PA-C (NPI 1194814376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467436089 NPI number — GOODWIN COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWIN COMMUNITY HEALTH
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:
6
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:
1467436089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 ROUTE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSWORTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03878-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-749-2346
Provider Business Mailing Address Fax Number:
603-953-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 ROUTE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSWORTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03878-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-749-2346
Provider Business Practice Location Address Fax Number:
603-953-0066
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ATKINS
Authorized Official First Name:
JANET
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
603-956-0063

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30011038 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138790101 . This is a "MAINECARE FFS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30312977 . This is a "DENTAL MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 138790200 . This is a "MAINE CARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 99909035 . This is a "ME MEDICAID PRIMECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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