Healthcare Provider Details

I. General information

NPI: 1134410319
Provider Name (Legal Business Name): CMC D/B/A URGENT CARE AT BEDFORD MEDICAL PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WASHINGTON PLACE
BEDFORD NH
03110
US

IV. Provider business mailing address

195 MCGREGOR ST SUITE 310
MANCHESTER NH
03102-3748
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-4567
  • Fax:
Mailing address:
  • Phone: 603-314-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWARD DUDLEY
Title or Position: EVP/CFO
Credential:
Phone: 603-663-6180