Provider Demographics
NPI:1386697803
Name:DARTMOUTH-HITCHCOCK CLINIC
Entity type:Organization
Organization Name:DARTMOUTH-HITCHCOCK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR,BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-653-2010
Mailing Address - Street 1:PO BOX 419100
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4125
Practice Address - Country:US
Practice Address - Phone:603-695-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X, 207RR0500X, 207V00000X, 207X00000X, 207Y00000X, 208000000X, 2080P0202X, 261QR0200X, 207K00000X, 207N00000X, 207R00000X, 207RC0000X, 207RG0100X, 207Q00000X
NH02552261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHCA5006OtherRAILROAD MEDICARE
NHCA5651OtherRAILROAD MEDICARE
NHCA9427OtherRAILROAD MEDICARE
NHCB9189OtherRAILROAD MEDICARE
NHDE5051OtherRAILROAD MEDICARE
NH3080894Medicaid
NHCA6501OtherRAILROAD
NHCC1439OtherRAILROAD MEDICARE
VT0000821Medicaid
NHDC7903OtherRAILROAD
NHCA0032OtherRAILROAD MEDICARE
NH3080411Medicaid
NHCN1486OtherRAILROAD MEDICARE
NHCN3827OtherRAILROAD MEDICARE
NH3081001Medicaid
NHCA4893OtherRAILROAD MEDICARE
NHCE1581OtherRAILROAD MEDICARE
NHCN1486OtherRAILROAD MEDICARE
NHCN3827OtherRAILROAD MEDICARE
NHCA9427OtherRAILROAD MEDICARE
VTVT9589Medicare PIN