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NPI Code Detail

MEDICARE: NEW CREATION HEALING CENTER, INC

MEDICARE: NEW CREATION HEALING CENTER, INC
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
1363L00000XNurse Practitioner
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3BCBSOTHERMAM17086
4TUFTSOTHERMA681554
5HEALTHSOURCEOTHERNH15221

General Provider Information

NPI Number : 1477569234
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW CREATION HEALING CENTER, INC
Provider Business Mailing Address
First Line : 80 ROUTE 125
Second Line :
City : KINGSTON
State : NH
Zip : 03848-3535
Country : US
Telephone Number : 603-642-6700
Fax Number : 603-642-6701
Provider Business Practice Location Address
First Line : 80 ROUTE 125
Second Line :
City : KINGSTON
State : NH
Zip : 03848-3535
Country : US
Telephone Number : 603-642-6700
Fax Number : 603-642-6701
Authorized Official
Title or Position : COO/PHYSICIAN
Name : MARY G PEARSON
Credential : DO
Telephone Number : 603-642-6700
Provider Enumeration Date : 08/01/2006
Last Update Date : 03/05/2009

Similar Medicare Providers

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1013481852 — CAROLEE JAYNE SMITH APRN,NP-FAMILY
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Directions to “NEW CREATION HEALING CENTER, INC ” Practice Location

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