Provider Demographics
NPI:1902027774
Name:PARKLAND PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:PARKLAND PHYSICIAN SERVICES INC
Other - Org Name:WOMENS PROGRESSIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-661-3365
Mailing Address - Street 1:44 BIRCH ST
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2752
Mailing Address - Country:US
Mailing Address - Phone:603-421-2460
Mailing Address - Fax:603-421-2479
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-421-2460
Practice Address - Fax:603-421-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007518Medicaid
NH30007518Medicaid
NHDD3775Medicare PIN