Basic Information
| Provider Information | |||||||||
| NPI: | 1386697803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DARTMOUTH-HITCHCOCK CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 419100 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022419100 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HITCHCOCK WAY | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031044125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036952500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR,BILLING OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6036532010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 261QA1903X | 02552 | NH | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 207K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CA5006 | 01 | NH | RAILROAD MEDICARE | OTHER | CA5651 | 01 | NH | RAILROAD MEDICARE | OTHER | CA9427 | 01 | NH | RAILROAD MEDICARE | OTHER | CB9189 | 01 | NH | RAILROAD MEDICARE | OTHER | DE5051 | 01 | NH | RAILROAD MEDICARE | OTHER | 3080894 | 05 | NH | MEDICAID | CA6501 | 01 | NH | RAILROAD | OTHER | CC1439 | 01 | NH | RAILROAD MEDICARE | OTHER | 0000821 | 05 | VT | MEDICAID | DC7903 | 01 | NH | RAILROAD | OTHER | CA0032 | 01 | NH | RAILROAD MEDICARE | OTHER | 3080411 | 05 | NH | MEDICAID | CN1486 | 01 | NH | RAILROAD MEDICARE | OTHER | CN3827 | 01 | NH | RAILROAD MEDICARE | OTHER | 3081001 | 05 | NH | MEDICAID | CA4893 | 01 | NH | RAILROAD MEDICARE | OTHER | CE1581 | 01 | NH | RAILROAD MEDICARE | OTHER |