Provider Demographics
NPI:1043390776
Name:CAPITAL REGION HEALTH VENTURES CORPORATION
Entity Type:Organization
Organization Name:CAPITAL REGION HEALTH VENTURES CORPORATION
Other - Org Name:CENTER FOR INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-225-2711
Mailing Address - Street 1:81 HALL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3488
Mailing Address - Country:US
Mailing Address - Phone:603-228-7600
Mailing Address - Fax:603-228-7320
Practice Address - Street 1:81 HALL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3488
Practice Address - Country:US
Practice Address - Phone:603-228-7600
Practice Address - Fax:603-228-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0172652301363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30210559Medicare UPIN
NHRE5638Medicare PIN