Basic Information
| Provider Information | |||||||||
| NPI: | 1851991251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONVENIENTMD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 NH AVE | ||||||||
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| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034106700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 HIGH ST | ||||||||
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| City: | ELLSWORTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046051715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074125200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOISSONNEAULT | ||||||||
| AuthorizedOfficialFirstName: | JAROD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE MGT | ||||||||
| AuthorizedOfficialTelephone: | 6033196223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.