Provider Demographics
NPI:1316026677
Name:SOUTHERN NEW HAMPSHIRE INTERNAL MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTHERN NEW HAMPSHIRE INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-216-0400
Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-216-0400
Mailing Address - Fax:603-216-3800
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-216-0400
Practice Address - Fax:603-216-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30211447Medicaid
NH30211447Medicaid
NHRE7527Medicare PIN