Healthcare Provider Details

I. General information

NPI: 1275702599
Provider Name (Legal Business Name): CHESHIRE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1718
US

IV. Provider business mailing address

580 COURT ST
KEENE NH
03431-1718
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5494
  • Fax:
Mailing address:
  • Phone: 603-354-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: MS. JOELLYN STACK
Title or Position: COMMUNITY HEALTH PROGRAM MANAGER
Credential: RD, LD, MPH
Phone: 603-354-5400