=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285918441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN NEW HAMPSHIRE VETERINARY REFERRAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 ABBY RD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-3363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-782-8181
-----------------------------------------------------
Fax | 603-782-8167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 ABBY RD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03103-3363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-782-8181
-----------------------------------------------------
Fax | 603-782-8167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JOSHUA ALEXANDER JASPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-782-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174M00000X
-----------------------------------------------------
Taxonomy Name | Veterinarian
-----------------------------------------------------
License Number | 1354
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------