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NPI Code Detail

MEDICARE: CONVENIENTMD LLC

MEDICARE: CONVENIENTMD LLC
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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1457970592
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONVENIENTMD LLC
Provider Business Mailing Address
First Line : 111 NEW HAMPSHIRE AVE
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-2864
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 193 BATH RD
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2607
Country : US
Telephone Number : 207-424-2272
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF REV CYCLE
Name : JAROD BOISSONNEAULT
Credential :
Telephone Number : 603-319-6223
Provider Enumeration Date : 04/09/2020
Last Update Date : 04/09/2020

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Directions to “CONVENIENTMD LLC ” Practice Location

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