Basic Information
| Provider Information | |||||||||
| NPI: | 1710592977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAMPREY HEALTH CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWMARKET | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038571835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036593106 | ||||||||
| FaxNumber: | 6036595892 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 TSIENNETO RD | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030381505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036593106 | ||||||||
| FaxNumber: | 6036595892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALWARDT | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING/CODING COMPLIANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6032927292 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LAMPREY HEALTH CARE INC | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.