Provider Demographics
NPI:1295856896
Name:EXPRESSMED, LLC
Entity Type:Organization
Organization Name:EXPRESSMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-625-2622
Mailing Address - Street 1:1 HIGHLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-7403
Mailing Address - Country:US
Mailing Address - Phone:603-625-2622
Mailing Address - Fax:603-626-1816
Practice Address - Street 1:1 HIGHLANDER WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-7403
Practice Address - Country:US
Practice Address - Phone:603-625-2622
Practice Address - Fax:603-626-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7412261QM2500X
NH03866261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100771Medicaid
NH0030903Medicare PIN