MEDICARE: TOWN OF DERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	0029	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7106297Y0NH01	OTHER	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	029000222	OTHER	TRICARE

General Provider Information

NPI Number	:	1073517934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF DERRY

Provider Business Mailing Address
First Line	:	PO BOX 9565
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03108-9565
Country	:	US
Telephone Number	:	603-432-6751
Fax Number	:	603-537-9216

Provider Business Practice Location Address
First Line	:	14 MANNING ST
Second Line	:
City	:	DERRY
State	:	NH
Zip	:	03038-3201
Country	:	US
Telephone Number	:	603-432-6751
Fax Number	:

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	CHUCK HEMEON
Credential	:
Telephone Number	:	603-432-6751

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/29/2012

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Directions to “TOWN OF DERRY ” Practice Location

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