Provider Demographics
NPI:1205047032
Name:OCCUPATIONAL HEALTH SERVICES OF PORTSMOUTH REGIONAL HOSPITAL, LLC
Entity type:Organization
Organization Name:OCCUPATIONAL HEALTH SERVICES OF PORTSMOUTH REGIONAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-430-9675
Mailing Address - Street 1:25 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2841
Mailing Address - Country:US
Mailing Address - Phone:603-430-9675
Mailing Address - Fax:603-334-6088
Practice Address - Street 1:25 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2841
Practice Address - Country:US
Practice Address - Phone:603-430-9675
Practice Address - Fax:603-334-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine