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NPI Code Detail

MEDICARE: CONVENIENTMD - FFS UC LLC

MEDICARE: CONVENIENTMD - FFS UC LLC
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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1154012698
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONVENIENTMD - FFS UC LLC
Provider Business Mailing Address
First Line : 360 US HIGHWAY 1 BYP UNIT 102
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-7105
Country : US
Telephone Number : 603-410-6700
Fax Number : 603-319-8308
Provider Business Practice Location Address
First Line : 193 BATH RD
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2607
Country : US
Telephone Number : 207-424-2272
Fax Number :
Authorized Official
Title or Position : VP, REVENUE CYCLE MGT
Name : JAROD BOISSONNEAULT
Credential :
Telephone Number : 603-410-6700
Provider Enumeration Date : 05/16/2023
Last Update Date : 11/29/2023

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