1982301289 NPI number — CONVENIENTMD LLC

Table of content: (NPI 1982301289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982301289 NPI number — CONVENIENTMD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONVENIENTMD 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:
1982301289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 NH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-410-6700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 DALTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-242-6577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOISSONNEAULT
Authorized Official First Name:
JAROD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, REVENUE CYCLE MGT
Authorized Official Telephone Number:
603-319-6223

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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