Provider Demographics
NPI:1568584290
Name:PORTSMOUTH ANESTHESIA ASSOCIATES PA
Entity Type:Organization
Organization Name:PORTSMOUTH ANESTHESIA ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKE MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-475-2010
Mailing Address - Street 1:PO BOX 845343
Mailing Address - Street 2:PORTSMOUTH ANETHESIA ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-5343
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:333 BORTHWICK AVENUE
Practice Address - Street 2:PORTSMOUTH ANESTHESIA ASSOCIATES
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-749-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007940Medicaid
NHNH9334Medicare PIN