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333 Nhroute 25 Warren NH 03279-4431 | |
(603) 764-5704 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 333 Nhroute 25, Warren, New Hampshire |
Authorized Official Name and Position | Edward D Shanshala Ii (DIRECTOR) |
Authorized Official Contact | 6034442464 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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25 Mount Eustis Rd Littleton NH 03561-3712 Ph: (603) 444-2464 | 333 Nhroute 25 Warren NH 03279-4431 Ph: (603) 764-5704 |
NPI Number | 1982821765 |
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Provider Enumeration Date | 04/20/2007 |
Last Update Date | 03/16/2009 |
Medicare PECOS PAC ID | 1052361664 |
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Medicare Enrollment ID | O20080228000543 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982821765 | NPI | - | NPPES |
80301806 | Medicaid | NH |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |