Provider Demographics
NPI:1346130713
Name:CONVENIENTMD FFS - UC LLC FARMINGTON
Entity type:Organization
Organization Name:CONVENIENTMD FFS - UC LLC FARMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REV CYCLE MGT
Authorized Official - Prefix:
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSONNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-319-6223
Mailing Address - Street 1:360 ROUTE 1 BYP
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:
Practice Address - Street 1:108 KNOWLTON CORNER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-578-7152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care