Provider Demographics
NPI:1689657520
Name:TOWN OF KINGSTON
Entity type:Organization
Organization Name:TOWN OF KINGSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-642-3626
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-0302
Mailing Address - Country:US
Mailing Address - Phone:603-642-3626
Mailing Address - Fax:603-642-6307
Practice Address - Street 1:148 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3222
Practice Address - Country:US
Practice Address - Phone:603-642-3626
Practice Address - Fax:603-642-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0060341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008909Medicaid
725857OtherTUFTS HEALTH PLAN
590010233OtherRR MEDICARE
71061229Y0NH01OtherANTHEM BLUE CROSS
701508OtherHARVARD PILGRIM
=========OtherTRICARE
NHNH6229Medicare PIN