Provider Demographics
NPI:1477886075
Name:1ST LINE MEDICAL, INC.
Entity Type:Organization
Organization Name:1ST LINE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-968-3172
Mailing Address - Street 1:854 US ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:HOLDERNESS
Mailing Address - State:NH
Mailing Address - Zip Code:03245
Mailing Address - Country:US
Mailing Address - Phone:603-968-3172
Mailing Address - Fax:603-968-3158
Practice Address - Street 1:854 US ROUTE 3
Practice Address - Street 2:
Practice Address - City:HOLDERNESS
Practice Address - State:NH
Practice Address - Zip Code:03245
Practice Address - Country:US
Practice Address - Phone:603-968-3172
Practice Address - Fax:603-968-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8064261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic