Provider Demographics
NPI:1346573391
Name:SEACOAST ORTHOPEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:SEACOAST ORTHOPEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:603-742-2007
Mailing Address - Street 1:7 MARSH BROOK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-6523
Mailing Address - Country:US
Mailing Address - Phone:603-742-2007
Mailing Address - Fax:603-749-4605
Practice Address - Street 1:65 CALEF HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:LEE
Practice Address - State:NH
Practice Address - Zip Code:03861-6703
Practice Address - Country:US
Practice Address - Phone:603-742-2007
Practice Address - Fax:603-749-4605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEACOAST ORTHOPEDICS & SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH83203676Medicaid
NH83203676Medicaid
NHNH3676Medicare PIN