MEDICARE: TRI-COUNTY COMMUNITY ACTION PROGRAM

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1922233766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY COMMUNITY ACTION PROGRAM

Provider Business Mailing Address
First Line	:	30 EXCHANGE ST
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-1911
Country	:	US
Telephone Number	:	603-323-7645
Fax Number	:	603-323-7647

Provider Business Practice Location Address
First Line	:	448 WHITE MOUNTAIN HWY
Second Line	:
City	:	TAMWORTH
State	:	NH
Zip	:	03886-4626
Country	:	US
Telephone Number	:	603-323-7645
Fax Number	:	603-323-7647

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	PETER HIGBEE
Credential	:
Telephone Number	:	603-752-7001

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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