Provider Demographics
NPI:1801885256
Name:PARKLAND PHYSICIAN SERVICES, INC
Entity type:Organization
Organization Name:PARKLAND PHYSICIAN SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:184 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3254
Mailing Address - Country:US
Mailing Address - Phone:603-434-9666
Mailing Address - Fax:603-425-2973
Practice Address - Street 1:184 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3254
Practice Address - Country:US
Practice Address - Phone:603-434-9666
Practice Address - Fax:603-425-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30214303Medicaid
NH30214303Medicaid
NH30214303Medicaid