Provider Demographics
NPI:1942443387
Name:DIABETES HEALTHCARE OF NH
Entity Type:Organization
Organization Name:DIABETES HEALTHCARE OF NH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MERVILLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:603-660-6780
Mailing Address - Street 1:63 LISA DR
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2833
Mailing Address - Country:US
Mailing Address - Phone:603-660-6780
Mailing Address - Fax:
Practice Address - Street 1:63 LISA DR
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2833
Practice Address - Country:US
Practice Address - Phone:603-660-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041658261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP66455Medicare UPIN
NHNP3889Medicare PIN