Basic Information
| Provider Information | |||||||||
| NPI: | 1134702954 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAMPREY HEALTH CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWMARKET | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038571843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036592494 | ||||||||
| FaxNumber: | 6036595892 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | RAYMOND | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030771220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038953351 | ||||||||
| FaxNumber: | 6036595892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2021 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 6036595494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LAMPREY HEALTH CARE, INC. | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.