Provider Demographics
NPI:1770793721
Name:NEW HAMPSHIRE PUBLIC HEALTH LABORATORIES
Entity type:Organization
Organization Name:NEW HAMPSHIRE PUBLIC HEALTH LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA, MT(ASCP)
Authorized Official - Phone:603-271-4657
Mailing Address - Street 1:29 HAZEN DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6503
Mailing Address - Country:US
Mailing Address - Phone:603-271-4661
Mailing Address - Fax:603-271-4760
Practice Address - Street 1:29 HAZEN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6503
Practice Address - Country:US
Practice Address - Phone:603-271-4661
Practice Address - Fax:603-271-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006267Medicaid
NH99908945Medicaid