Provider Demographics
NPI:1073517934
Name:TOWN OF DERRY
Entity Type:Organization
Organization Name:TOWN OF DERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-432-6751
Mailing Address - Street 1:PO BOX 9565
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03108-9565
Mailing Address - Country:US
Mailing Address - Phone:603-432-6751
Mailing Address - Fax:603-537-9216
Practice Address - Street 1:14 MANNING ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-3201
Practice Address - Country:US
Practice Address - Phone:603-432-6751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0029341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1710532Medicaid
7106297Y0NH01OtherANTHEM BC/BS
NH80596297Medicaid
029000222OtherTRICARE
NHAM0149Medicare ID - Type Unspecified
NH80596297Medicaid