Healthcare Provider Details

I. General information

NPI: 1093753881
Provider Name (Legal Business Name): PARKLAND PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PELHAM RD
SALEM NH
03079-4818
US

IV. Provider business mailing address

18 PELHAM RD
SALEM NH
03079-4818
US

V. Phone/Fax

Practice location:
  • Phone: 603-894-0500
  • Fax: 603-894-0535
Mailing address:
  • Phone: 603-894-0500
  • Fax: 603-894-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12997
License Number StateNH

VIII. Authorized Official

Name: MRS. CAROL ANN SMITH
Title or Position: V.P.
Credential:
Phone: 603-894-0500