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General NPI Number Information
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NPI Number | 1275535999
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Entity Type | Organization
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Legal Business Name | COOS COUNTY FAMILY HEALTH SERVICES, INC
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 2 BROADWAY AVE
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City | GORHAM
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State | NH
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Zip | 03581-1502
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Country | US
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Telephone | 603-466-2741
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Fax | 603-466-2953
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Provider Business Mailing Address
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Address Line | 133 PLEASANT ST
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City | BERLIN
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State | NH
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Zip | 03570-2006
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Country | US
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Telephone | 603-752-2040
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Fax | 603-752-7797
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Authorized Official
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Title or Position | CEO
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Name | KENNETH GORDON
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Credential |
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Telephone | 603-752-3669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | NH
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NH
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Taxonomy #7
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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