1801853510 NPI number — DUNNING ST. AMBULATORY CARE CENTER, LLC

Table of content: (NPI 1801853510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801853510 NPI number — DUNNING ST. AMBULATORY CARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNNING ST. AMBULATORY CARE 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:
1801853510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DUNNING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03743-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-543-3501
Provider Business Mailing Address Fax Number:
603-542-6486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 DUNNING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-543-3501
Provider Business Practice Location Address Fax Number:
603-542-6486
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRADLEY
Authorized Official First Name:
JYL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
603-543-3501

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00800328 . This is a "VERMONT BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 30005202 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0301007 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com