Provider Demographics
NPI:1912949496
Name:SEACOAST AREA PHYSIATRY, PC
Entity Type:Organization
Organization Name:SEACOAST AREA PHYSIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-431-5529
Mailing Address - Street 1:875 GREENLAND RD
Mailing Address - Street 2:BUILDING C-4
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4164
Mailing Address - Country:US
Mailing Address - Phone:603-431-5529
Mailing Address - Fax:603-436-6603
Practice Address - Street 1:875 GREENLAND RD
Practice Address - Street 2:BUILDING C-4
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4164
Practice Address - Country:US
Practice Address - Phone:603-431-5529
Practice Address - Fax:603-436-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001524Medicaid
NH80001524Medicaid