Basic Information
| Provider Information | |||||||||
| NPI: | 1326587635 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPEARE MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PLYMOUTH PEDIATRIC AND ADOLESCENT MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 16 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032641126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361120 | ||||||||
| FaxNumber: | 6035364828 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 HIGHLAND ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032641233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035363700 | ||||||||
| FaxNumber: | 6035365384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2017 | ||||||||
| LastUpdateDate: | 09/27/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCEWEN | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 6035361120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 01300 | NH | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.