=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609691781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL KELLIHER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2024
-----------------------------------------------------
Last Update Date | 07/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 S RIVER RD STE 100
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-665-5150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 S RIVER RD STE 100
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-665-5150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Registered Nurse
-----------------------------------------------------
License Number | 075745-21
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 075745-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------