Provider Demographics
NPI:1245900620
Name:MANCHESTER BEDFORD MYOSKELETAL LLC
Entity type:Organization
Organization Name:MANCHESTER BEDFORD MYOSKELETAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUYOUMJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT MMT
Authorized Official - Phone:603-622-1112
Mailing Address - Street 1:111 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6730
Mailing Address - Country:US
Mailing Address - Phone:603-622-1112
Mailing Address - Fax:888-965-6870
Practice Address - Street 1:111 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6730
Practice Address - Country:US
Practice Address - Phone:603-622-1112
Practice Address - Fax:888-965-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center