Provider Demographics
NPI:1639471501
Name:NEW HAMPSHIRE PHS LLC
Entity Type:Organization
Organization Name:NEW HAMPSHIRE PHS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-261-4848
Mailing Address - Street 1:9155 CRESTWYN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8501
Mailing Address - Country:US
Mailing Address - Phone:901-261-4848
Mailing Address - Fax:901-261-4867
Practice Address - Street 1:1950 LAFAYETTE RD
Practice Address - Street 2:SUITE 201 BOX 1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8663
Practice Address - Country:US
Practice Address - Phone:901-261-4848
Practice Address - Fax:901-261-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0019476Medicare PIN