Provider Demographics
NPI:1336323229
Name:DIABETES HEALTHCARE OF NH, LLC
Entity Type:Organization
Organization Name:DIABETES HEALTHCARE OF NH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:603-232-8344
Mailing Address - Street 1:264 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6824
Mailing Address - Country:US
Mailing Address - Phone:603-232-8344
Mailing Address - Fax:603-628-2288
Practice Address - Street 1:264 S RIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6824
Practice Address - Country:US
Practice Address - Phone:603-232-8344
Practice Address - Fax:603-628-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0416582303363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP66455Medicare UPIN
NHNP3889Medicare PIN