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NPI Code Detail

MEDICARE: COOS COUNTY FAMILY HEALTH SERVICES, INC

MEDICARE: COOS COUNTY FAMILY HEALTH SERVICES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerNH
2363A00000XPhysician AssistantNH
3363LP0200XPediatric Nurse PractitionerNH
4133V00000XRegistered DietitianNH
5207Q00000XFamily Medicine PhysicianNH
6261QF0050XNon-Surgical Family Planning Clinic/Center
7261QR1300XRural Health Clinic/Center
8207R00000XInternal Medicine PhysicianNH
9207V00000XObstetrics & Gynecology PhysicianNH
10261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CN7051OTHERMEDICARE RAILROAD
4NH2315OTHERNHMEDICARE B

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346242054
Entity Type Code : Organization
Provider Name (Legal Business Name) : COOS COUNTY FAMILY HEALTH SERVICES, INC
Provider Business Mailing Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-7797
Provider Business Practice Location Address
First Line : 133 PLEASANT ST
Second Line :
City : BERLIN
State : NH
Zip : 03570-2006
Country : US
Telephone Number : 603-752-2040
Fax Number : 603-752-7797
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : KENNETH GORDON
Credential : CEO
Telephone Number : 603-752-3669
Provider Enumeration Date : 08/12/2005
Last Update Date : 01/10/2018

Similar Medicare Providers

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1962403238 — JEANNE D CHAREST APRN
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1336141225 — PATRICIA SHUTE ARNP
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1184626012 — MARIANNE JACKSON DO
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1619979564 — CHRISTOPHER LAKE MD
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Directions to “COOS COUNTY FAMILY HEALTH SERVICES, INC ” Practice Location

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