Provider Demographics
NPI: | 1033118104 |
---|---|
Name: | WENTWORTH DOUGLASS HOSPITAL |
Entity Type: | Organization |
Organization Name: | WENTWORTH DOUGLASS HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VP OF FINANCE |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DEGENAARS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 603-742-5252 |
Mailing Address - Street 1: | PO BOX 412540 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02241-2540 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-740-2400 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 789 CENTRAL AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | DOVER |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03820 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-740-2400 |
Practice Address - Fax: | 603-740-2244 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-20 |
Last Update Date: | 2023-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
2085R0202X, 2085U0001X, 247100000X, 2471B0102X, 2471M2300X, 261QP2000X, 261QP3300X, 261QR0200X, 261QR0400X, 261QU0200X, 261QX0100X, 261QX0203X, 282N00000X, 291U00000X | ||
NH | 00010 | 282N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Single Specialty | |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Single Specialty |
No | 247100000X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Group - Single Specialty | |
No | 2471B0102X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry | Group - Single Specialty |
No | 2471M2300X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Mammography | Group - Single Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Single Specialty |
No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | Group - Single Specialty |
No | 261QR0200X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | Group - Single Specialty |
No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Single Specialty |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | Group - Single Specialty |
No | 261QX0203X | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation | |
No | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 3127023 | Medicaid | |
NH | 3137697 | Medicaid | |
NH | 3126778 | Medicaid | |
NH | 3074430 | Medicaid |