1952384299 NPI number — MERRIMACK RIVER MEDICAL SERVICES, INC.

Table of content: (NPI 1952384299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952384299 NPI number — MERRIMACK RIVER MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRIMACK RIVER MEDICAL SERVICES, INC.
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:
1952384299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 LAKEPOINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-6458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-379-3300
Provider Business Mailing Address Fax Number:
214-853-9018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 DERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03051-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-595-3399
Provider Business Practice Location Address Fax Number:
603-579-2734
Provider Enumeration Date:
11/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JARVIE
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, TREASURER
Authorized Official Telephone Number:
214-379-3300

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 820000309 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".