Basic Information
| Provider Information | |||||||||
| NPI: | 1841342540 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPEARE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032641126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032382204 | ||||||||
| FaxNumber: | 6035362034 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 BOULDER POINT DRIVE | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361881 | ||||||||
| FaxNumber: | 6032382198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCEWEN | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 6035361120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 01300 | NH | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1017704 | 05 | VT | MEDICAID | 30517874 | 05 | NH | MEDICAID | 3083028 | 05 | NH | MEDICAID |