Basic Information
| Provider Information | |||||||||
| NPI: | 1407060676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUR MEDICAL HOME LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2200 | ||||||||
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| City: | AMHERST | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030314200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 HAMPTON RD | ||||||||
| Address2: | BUILDING 2, SUITE 201 | ||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038334831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034186310 | ||||||||
| FaxNumber: | 6034186311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLOOMER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6034186310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.