Provider Demographics
| NPI: | 1841202512 |
|---|---|
| Name: | LAMPREY HEALTH CARE INC |
| Entity Type: | Organization |
| Organization Name: | LAMPREY HEALTH CARE INC |
| Other - Org Name: | LAMPREY HEALTH CARE-NASHUA CENTER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | GREGORY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WHITE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 603-659-2494 |
| Mailing Address - Street 1: | 22 PROSPECT ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NASHUA |
| Mailing Address - State: | NH |
| Mailing Address - Zip Code: | 03060-3924 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 603-883-1626 |
| Mailing Address - Fax: | 603-881-9914 |
| Practice Address - Street 1: | 22 PROSPECT ST |
| Practice Address - Street 2: | |
| Practice Address - City: | NASHUA |
| Practice Address - State: | NH |
| Practice Address - Zip Code: | 03060-3924 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 603-883-1626 |
| Practice Address - Fax: | 603-881-9914 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | LAMPREY HEALTH CARE |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-08-12 |
| Last Update Date: | 2019-03-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 1041C0700X, 133V00000X, 261QF0400X, 363LF0000X, 363LP0808X | ||
| NH | 02850 | 207Q00000X, 207V00000X, 208000000X, 363A00000X, 363L00000X, 367A00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NH | 3073143 | Medicaid | |
| ========= | Other | UNITED HEALTHCARE | |
| NH | 3073143 | Medicaid | |
| ========= | Other | HARVARD PILGRIM | |
| NH | RE2315 | Medicare PIN | |
| ========= | Other | UNITED HEALTHCARE |
