=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780648915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN NEW HAMPSHIRE RADIOLOGY CONSULTANTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2006
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 RIVERWAY PL
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-627-1661
-----------------------------------------------------
Fax | 603-669-6944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 RIVERWAY PL
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03110-6768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-627-1661
-----------------------------------------------------
Fax | 603-669-6944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | SARAH CARBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-627-1661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------