Healthcare Provider Details

I. General information

NPI: 1043283831
Provider Name (Legal Business Name): HERRON & SMITH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 INDUSTRIAL PARK DR STE. 20
HOOKSETT NH
03106-1805
US

IV. Provider business mailing address

8 INDUSTRIAL PARK DR STE. 20
HOOKSETT NH
03106-1805
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-8500
  • Fax: 603-626-0502
Mailing address:
  • Phone: 603-627-8500
  • Fax: 603-626-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number02877
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number02877
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number02877
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3078970
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier619864
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerHARVARD PILGRIM PROV. #
# 3
Identifier1043283831
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerCIGNA/CARECENTRIX
# 4
Identifier20381521
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 5
Identifier0007482
Identifier TypeMEDICAID
Identifier StateVT
Identifier Issuer
# 6
Identifier7482
Identifier TypeOTHER
Identifier StateVT
Identifier IssuerBC/BS PROVIDER NUMBER

VIII. Authorized Official

Name: TAMME J DUSTIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 603-627-8500