Basic Information
| Provider Information | |||||||||
| NPI: | 1740410133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEACOAST EMERGENCY PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845398 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022845398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774854474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 CALEF HWY | ||||||||
| Address2: | |||||||||
| City: | LEE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038616703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038688507 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | KOLM | ||||||||
| AuthorizedOfficialFirstName: | LUKAS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6037425252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.