Healthcare Provider Details

I. General information

NPI: 1467040253
Provider Name (Legal Business Name): FIREMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRAFALGAR SQ FL 1
NASHUA NH
03063-1998
US

IV. Provider business mailing address

1 TRAFALGAR SQ
NASHUA NH
03063-1998
US

V. Phone/Fax

Practice location:
  • Phone: 603-402-2242
  • Fax:
Mailing address:
  • Phone: 978-230-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PROF. ANTHONY CLAUDE PERKINS
Title or Position: CO-OWNER
Credential: CRV
Phone: 603-402-2242