Provider Demographics
NPI:1588855647
Name:PRESCOTT PEDIATRIC CARE, PC
Entity Type:Organization
Organization Name:PRESCOTT PEDIATRIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-393-9535
Mailing Address - Street 1:171 DANIEL WEBSTER HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220-3053
Mailing Address - Country:US
Mailing Address - Phone:603-524-5777
Mailing Address - Fax:603-524-0553
Practice Address - Street 1:171 DANIEL WEBSTER HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-3053
Practice Address - Country:US
Practice Address - Phone:603-524-5777
Practice Address - Fax:603-524-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care